Methods for treating dependence

ABSTRACT

Provided are methods of treating patients suffering from or susceptible to at least one symptom of abuse of, dependence on, or withdrawal from at least one substance with Compound A. Also provided are methods of treating at least one phase of substance dependence on at least one substance in patients and certain methods of treating at least one phase of cocaine dependence in patients.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. Ser. No. 14/099,882, filedDec. 6, 2013, which is a continuation of U.S. Ser. No. 12/187,166 filedAug. 6, 2008 which claims the benefit of and priority under 35 U.S.C. §119(e) to U.S. Provisional Patent Application Serial Nos. 60/935,323,“Methods for Treating Dependence Using Nepicastat” filed Aug. 6, 2007,60/956,555, “Methods for Treating Dependence Using Nepicastat” filedAug. 17, 2007, and 60/960,591, “Methods for Treating Dependence UsingNepicastat” filed Oct. 4, 2007, which are all incorporated herein byreference in their entirety.

FIELD OF INVENTION

Provided are certain methods of treating patients suffering from orsusceptible to at least one symptom of abuse of, dependence on, orwithdrawal from at least one substance with Compound A. Also providedare certain methods of treating at least one phase of substancedependence on at least one substance in patients and certain methods oftreating at least one phase of cocaine dependence in patients.

BACKGROUND OF THE INVENTION

Substance abuse and dependence are characterized by substance craving,seeking, and use with loss of control in limiting intake of thesubstance. These behaviors occur despite significant substance userelated problems and at the expense of other behaviors. In 2004,approximately 22.5 million Americans aged 12 or older needed treatmentfor substance (alcohol or illicit drug) abuse. The latest estimate forthe costs to society of illicit drug abuse alone is $181 billion (2002).

The problem of cocaine abuse and dependence is a major medical, social,and legal concern. According to the 2005 National Survey on Drug Use andHealth, approximately 13.9% of Americans aged 12 and older have triedcocaine at least once in their lifetimes and 3.3% have tried crackcocaine at least once in their lifetimes. More troublesome, in 2005,there were 2.4 million persons who were current cocaine users, which isgreater than in 2004 when the number was 2.0 million. Similarly, thenumber of current crack users increased from 467,000 in 2004 to 682,000in 2005. In 2004, the Drug Abuse Warning Network estimated 940,953drug-related emergency room visits nationwide, and cocaine was theinvolved in the majority of these.

Clearly, there is a need for a broadly effective treatment approach, andone including a medication component may be more effective than currentbehavioral treatments such as cognitive behavioral therapy orcontingency management alone. A variety of treatments have been studiedin clinical trials, without noteworthy success. In particular, numerousrandomized controlled clinical trials of antidepressants have beencompleted, including trials of desipramine, fluoxetine, bupropion, andimipramine. Clinical trials of mood stabilizers, including carbamazepineand lithium have also been completed, as have trials of phenytoin,direct or indirect dopamine agonists, including bromocriptine,pergolide, amantadine, mazindole, and methylphenidate. A range of otheragents, including ritanserin, gepirone, nimodipine, and naltrexone havebeen studied as well. None of these compounds has proved reliablyefficacious. Several medications acting on GABA systems have beenevaluated as treatments for cocaine dependence, including tiagabine,baclofen, and vigabatrin. Results for tiagabine have been equivocal,those for baclofen have been slightly more encouraging, though notcompelling. Studies of vigabatrin have been perhaps equally encouraging,though based primarily on open-label trials. The outcomes from thesedevelopment efforts have generally been discouraging.

The dopamine β-hydroxylase (DBH) inhibitor disulfiram is the mosteffective pharmacologic treatment for cocaine dependence currentlyavailable. Unfortunately, disulfiram non-specifically inhibits severalenzymes, including aldehyde dehydrogenase and plasma esterases.Disulfiram and related compounds chelate copper, which is a necessarycofactor for a variety of enzymes, including aldehyde dehydrogenase,plasma esterases and DBH. By inhibiting aldehyde dehydrogenase,disulfiram alters the metabolism of alcohol (ethanol), producing thedisulfiram-ethanol reaction. This reaction consists of flushing, nausea,and hypotension.

Inhibition of plasma esterases slows the elimination of cocaine, whichcan result in elevations in plasma cocaine levels. In laboratory studiesevaluating effects of intranasal cocaine during treatment withdisulfiram, disulfiram treatment markedly increased plasma cocainelevels. Increased cocaine levels were not associated with alterations inphysiologic or subjective effects of cocaine, however. Six-foldelevations in plasma cocaine levels were observed in one controlledstudy, and greater elevations may occur in the context of uncontrolledillicit use. A subsequent study using IV cocaine dosing documented thatdisulfiram slowed the elimination of cocaine, presumably by inhibitingplasma esterases. Slow absorption following intranasal dosing accountedfor the increases in plasma concentrations observed earlier.

Several studies have shown preliminary efficacy of disulfiram as atreatment of cocaine dependence. In human laboratory studies, treatmentwith disulfiram reduced the positive subjective effects produced bycocaine. Patients with comorbid alcohol and cocaine dependence hadimproved outcomes when treated with disulfiram, up to 500 mg. Similarly,buprenorphine-maintained opiate- and cocaine-dependent patients reducedcocaine use during treatment with disulfiram. Recently, results from alarge clinical trial suggested that disulfiram 250 mg per day wasassociated with reduced cocaine use compared to placebo, regardless ofalcohol use pattern or type of psychotherapy provided. In this study,112 cocaine-dependent volunteers were randomized to placebo ordisulfiram, and provided one of two psychotherapies. Disulfiramtreatment was associated with reduced cocaine use documented by theprovision of fewer cocaine-positive urine samples compared to placebotreatment. The effect size was modest and this outcome remains to bereplicated.

Disulfiram inhibits DBH, the single enzyme that mediates the synthesisof norepinephrine (NE). DBH is expressed in noradrenergic neurons and islocalized within synaptic vesicles and is released along with NE. DBHcan be measured in the plasma, and the concentration of DBH is highlyheritable and variability in activity is largely accounted for byvariability at the DBH locus. The T variant (−1021C→T) is associatedwith diminished DBH gene transcription and with lower DBH activity. Thisallele is fairly common. The frequency of the T allele is reported to be20% among African-Americans, 22% among Northern European Americans and16% among Japanese. The corresponding haplotype frequencies are 0.32,0.34, and 0.09 for these populations, respectively.

Several reports indicate that disulfiram is more effective in patientswith lower DBH activity. It has been shown that in subjects with low DBHactivity, the proportion of cocaine-positive urines decreased over timeduring treatment with disulfiram 250 mg/day relative to placebo butsignificantly increased over time during treatment with 62.5 mg and 125mg disulfiram/day (p's<0.04). In those with high DBH activity, theproportion of cocaine-positive urines increased over time withdisulfiram at 62.5 mg/day relative to placebo (p=0.001). Thus, theefficacy of 250 mg/day disulfiram treatment appears limited to thosewith low DBH activity, which corresponds to the C→T genotype. Doses ofdisulfiram lower than 250 mg/day appear to increase cocaine use,possibly by reducing cocaine clearance by inhibiting plasma esterases,thus increasing the abuse-related euphoric effects of cocaine.

Disulfiram more effectively reduces cocaine use in patients with the DBHC→T genotype associated with lower DBH activity. Presumably, disulfirammore completely inhibits DBH in those with lower DBH activity, so thatdisulfiram is more effective in those with the lower activity C→Tgenotype. The observation that disulfiram is more effective in patientswith the low-activity DBH C→T genotype confirms that inhibition of DBHis a key mechanism of action for disulfiram as a therapy for cocainedependence.

While disulfiram provides a proof-of-concept that DBH inhibitors arepromising treatments for cocaine dependence, the usefulness ofdisulfiram itself as a treatment for cocaine dependence is severelylimited by its interactions with alcohol and cocaine.

SUMMARY OF THE INVENTION

Provided are methods of treating patients suffering from or susceptibleto at least one symptom of abuse of, dependence on, or withdrawal fromat least one substance. The methods include administering to the patienta therapeutically effective amount of Compound A.

Also provided are methods of treating at least one phase of substancedependence on at least one substance in a patient, in which the at leastone phase is selected from acquisition, maintenance, extinction, andrelapse. The methods include administering to the patient atherapeutically effective amount of Compound A.

Also provided are methods of treating at least one phase of cocainedependence in a patient, in which the at least one phase is selectedfrom acquisition, maintenance, extinction, and relapse. The methodsinclude administering to the patient a therapeutically effective amountof Compound A.

DESCRIPTION OF DRAWINGS

FIG. 1 shows the effect size achieved with sample sizes ranging from 5to 15.

FIG. 2 shows the details of the individual enzymatic assays.

FIG. 3 shows a table with the affinities (IC50s or PKi) of nepicastatwith DBH and a range of selected enzymes and receptors.

FIG. 4 shows the effects of nepicastat on % inhibition of enzymeactivity.

FIG. 5 shows the urinary dopamine levels in normal volunteers after 24hour treatment with nepicastat.

FIG. 6 shows the norepinephrine levels in the cortex in SHRs dosed withvehicle or varying doses of nepicastat.

FIG. 7 shows the dopamine levels in the cortex in SHRs dosed withvehicle or varying doses of nepicastat.

FIG. 8 shows the dopamine/norepinephrine ratio in the cortex in SHRsdosed with vehicle or varying doses of nepicastat.

FIG. 9 shows the norepinephrine levels in the mesenteric artery in SHRsdosed with vehicle or varying doses of nepicastat.

FIG. 10 shows the dopamine levels in the mesenteric artery in SHRs dosedwith vehicle or varying doses of nepicastat.

FIG. 11 shows the dopamine/norepinephrine ratio in the mesenteric arteryin SHRs dosed with vehicle or varying doses of nepicastat.

DETAILED DESCRIPTION

As used in the present specification, the following words and phrasesare generally intended to have the meanings as set forth below, exceptto the extent that the context in which they are used indicatesotherwise.

As used herein “Compound A” includes(S)-5-Aminomethyl-1-(5,7-difluoro-1,2,3,4-tetrahydronaphth-2-yl)-2,3-dihydro-2-thioxo-1H-imidazole,(R)-5-Aminomethyl-1-(5,7-difluoro-1,2,3,4-tetrahydronaphth-2-yl)-2,3-dihydro-2-thioxo-1H-imidazole,and mixtures thereof, as well as pharmaceutically acceptable saltsthereof, such as the hydrochloride salt. In some embodiments nepicastatis used((S)-5-Aminomethyl-1-(5,7-difluoro-1,2,3,4-tetrahydronaphth-2-yl)-2,3-dihydro-2-thioxo-1H-imidazolehydrochloride).

As used herein, “Compound B” refers to(R)-5-Aminomethyl-1-(5,7-difluoro-1,2,3,4-tetrahydronaphth-2-yl)-2,3-dihydro-2-thioxo-1H-imidazole,as well as pharmaceutically acceptable salts thereof, such as thehydrochloride salt.

“Pharmaceutically acceptable salts” include, but are not limited tosalts with inorganic acids, such as hydrochlorate, phosphate,diphosphate, hydrobromate, sulfate, sulfinate, nitrate, and like salts;as well as salts with an organic acid, such as malate, maleate,fumarate, tartrate, succinate, citrate, acetate, lactate,methanesulfonate, p-toluenesulfonate, 2-hydroxyethylsulfonate, benzoate,salicylate, stearate, and alkanoate such as acetate, HOOC—(CH2)n-COOHwhere n is 0-4, and like salts.

In addition, if a compound is obtained as an acid addition salt, thefree base can be obtained by basifying a solution of the acid salt.Conversely, if the product is a free base, an addition salt,particularly a pharmaceutically acceptable addition salt, may beproduced by dissolving the free base in a suitable organic solvent andtreating the solution with an acid, in accordance with conventionalprocedures for preparing acid addition salts from base compounds. Thoseskilled in the art will recognize various synthetic methodologies thatmay be used to prepare non-toxic pharmaceutically acceptable additionsalts.

The term “patient,” as used herein, refers to a mammal. In certainembodiments, the term “patient” refers to a human.

The terms “administer,” “administering,” or “administration,” as usedherein, refer to either directly administering Compound A or acomposition thereof to a patient.

The terms “treat” or “treating,” as used herein, refers to partially orcompletely alleviating, inhibiting, preventing, ameliorating and/orrelieving the condition, or at least one symptom thereof.

The terms “suffer” or “suffering” as used herein refers to one or moreconditions that a patient has been diagnosed with, or is suspected tohave.

The term “susceptible” as used herein refers to having a likelihood ofbeing affected by at least one symptom of a condition.

Those of ordinary skill in the art will appreciate that “substanceabuse” often involves symptoms of physical and/or psychological“dependence.” Also, when the substance of abuse is withdrawn from adependent individual, the individual often develops certain symptomsincluding sleep and mood disturbance and intense craving of thesubstance of abuse, known as “withdrawal.” The methods described hereinencompass treatment of substance abuse itself, dependence, and also ofwithdrawal.

The term “substance abuse,” as used herein, can be defined withreference to criteria set forth in the Diagnostic and Statistical Manualof Mental Disorders, 4th Ed. Text revision (2000) (“DSM-IV TR”), whichwas prepared by the Task Force on DSM-IV of the American PsychiatricAssociation. A feature of substance abuse is a maladaptive pattern ofsubstance use manifested by recurrent and significant adverseconsequences related to the repeated use of substances. As recited inthe DSM-IV TR, substance abuse is defined as maladaptive pattern ofsubstance abuse leading to clinically significant impairment ordistress, as manifested by at least one of the following symptoms,occurring within a 12-month period: (1) recurrent substance useresulting in a failure to fulfill major role obligations at work,school, or home; (2) recurrent substance use in situations in which itis physically hazardous; (3) recurrent substance-related legal problems;and (4) continued substance use despite having persistent or recurrentsocial or interpersonal problems caused or exacerbated by the effects ofthe substance. In addition, the DSM-IV TR requires that the symptoms ofsubstance abuse have never met the criteria for substance dependence. Insome embodiments, treatment of substance abuse with nepicastat reducesthe amount or frequency of substance use in a patient. In someembodiments, treatment of substance abuse with Compound A in a patientreduces at least one DSM-IV TR symptom for substance abuse. In someembodiments, treatment with Compound A in a patient reduces at least onesymptom of substance abuse which includes by way of example and withoutlimitation at least one of euphoria, apathy, irritability, recklessness,poor judgment, compulsion, aggression, anger, craving for the substancebeing abused, and mood disorders. In some embodiments, treatment withCompound A reduces the substance craving induced by a stressful event ina patient.

As used herein, the phrase “reduces a symptom” refers to reducing atleast one of the frequency and amplitude of a symptom of a condition ina patient. In certain embodiments the patient enters remission and nolonger experiences the symptom.

As used herein, the phrase “increases a symptom” refers to increasing atleast one of the frequency and amplitude of a symptom of a condition ina patient.

The term “substance dependence,” as used herein, can be defined withreference to criteria set forth in the DSM-IV TR. The symptoms forsubstance dependence set forth in DSM-IV TR is a pattern of substanceuse, leading to clinically significant impairment or distress asmanifested by at least three selected from the following group,occurring at any time within the same twelve month period: (1) toleranceas defined by either (a) a need for substantially increased amounts ofthe substance to achieve the desired effect; or (b) substantiallydiminished effect with continued use of the same amount of thesubstance; (2) withdrawal, as demonstrated by either (a) thecharacteristic withdrawal syndrome for the specific substance; or (b)the same, or a closely related substance is taken to relieve or avoidwithdrawal symptoms; (3) the substance is often taken in larger amountsor over a longer period than was intended; (4) there is a persistentdesire or unsuccessful efforts to cut down or control substance use; (5)a great deal of time is spent in activities to obtain the substance, usethe substance, or recover from its effects; (6) important social,occupational or recreational activities are given up or reduced becauseof substance use; and (7) the substance use is continued despiteknowledge of having a persistent or recurrent physical or psychologicalproblem that is likely to have been caused or exacerbated by thesubstance. Substance dependence can be with physiological dependence,where evidence of tolerance or withdrawal is present, or withoutphysiological dependence, where no evidence of tolerance or withdrawalis present. In some embodiments, Compound A treatment of substancedependence reduces the amount or frequency of substance use by apatient. In some embodiments, Compound A treatment of substancedependence reduces at least one DSM-IV TR symptom for substancedependence in a patient. In some embodiments, treatment with Compound Ain a patient reduces at least one symptom of substance dependence whichincludes by way of example and without limitation at least one ofeuphoria, apathy, irritability, recklessness, poor judgment, compulsion,aggression, anger, craving for the substance depended upon, and mooddisorders. In some embodiments, treatment with Compound A reduces thesubstance craving induced by a stressful event in a patient.

As used herein, “remission” refers to a state during which theoccurrence of at least one symptom of substance abuse or dependence hasbeen reduced. In some embodiments, the term remission does not apply ifthe patient is on agonist therapy or in a controlled environment whereaccess to the relevant substance is restricted. In some embodimentsremission refers to a state during which the occurrence of at least onesymptom of substance abuse or dependence does not occur. In someembodiments, remission refers to a state during which all symptoms ofsubstance abuse or dependence have been reduced in a patient. In someembodiments, remission refers to a state during which no symptoms ofsubstance abuse or dependence occur. In some embodiments, remissionrefers to a state during which substance use does not occur.

In some embodiments, the remission is characterized by at least one ofearly full remission, early partial remission, sustained full remission,and sustained partial remission and only applies after none of thesymptoms for substance abuse and dependence have been present for atleast one month. The definition of these four types of remission arebased on the interval of time that has elapsed since the cessation ofdependence (early versus sustained remission) and whether there iscontinued presence of at least one symptom of substance dependence orabuse (partial versus full remission).

The qualifier “early full remission” is used when for at least onemonth, but for less than twelve months, no symptom of substancedependence or substance abuse has been met.

The qualifier “early partial remission” is used when for at least onemonth but less than 12 months, at least one symptom of substancedependence or substance abuse has been met, but the criteria forsubstance dependence or substance abuse have not been met.

The term “sustained full remission” is used when none of the symptoms ofsubstance dependence or substance abuse have been met at any time duringa period of at least twelve months.

The term “sustained partial remission” is used when for at least twelvemonths, at least one symptom of substance dependence or substance abusehas been met, but the criteria for substance dependence or substanceabuse have not been met.

In some embodiments, Compound A treatment promotes remission in apatient. In some embodiments, Compound A treatment prolongs a period ofremission period in a patient.

The phrase “prolong a period of remission” refers to increasing theinterval of time during which the patient is in remission. In someembodiments, a stressful event can cause remission to end in a patient.In some embodiments, relapse occurs at the end of remission. In someembodiments, Compound A treatment reduces the likelihood that remissionwill end in a patient after a stressful event. In some embodiments,Compound A treatment promotes at least one of early partial remission,sustained full remission, sustained partial remission, and sustainedfull remission.

“Withdrawal” refers to a collection of symptoms that arise whenadministration of a relevant substance is reduced, delayed, or stopped.The substance-specific symptoms of withdrawal can cause clinicallysignificant distress or impairment in social, occupational or otherimportant areas of functioning, for example. These symptoms are not dueto a general medical condition and are not better accounted for byanother mental disorder. Withdrawal usually, but not necessarily, isassociated with substance dependence. In some embodiments, treatmentwith Compound A reduces at least one symptom of withdrawal in a patient.In some embodiments, withdrawal symptoms include for example and withoutlimitation apathy, irritability, recklessness, poor judgment,compulsion, aggression, anger, substance craving, mood disorders, andsleep disorders. In some embodiments, treatment with Compound A reducesthe substance craving induced by a stressful event in a patient.

The term substance dependence can be characterized by the presence of atleast one of the following conditions characterized in the DSM-IV TR:Alcohol Abuse; Alcohol Dependence; Alcohol Intoxication; AlcoholIntoxication Delirium; Alcohol Withdrawal; Alcohol Withdrawal Delirium;Alcohol-Induced Anxiety Disorder; Alcohol-Induced Mood Disorder;Alcohol-Induced Persisting Amnestic Disorder; Alcohol-Induced PersistingDementia; Alcohol-Induced Psychotic Disorder, With Delusions;Alcohol-Induced Psychotic Disorder, With Hallucinations; Alcohol-InducedSexual Dysfunction; Alcohol-Induced Sleep Disorder; Alcohol-RelatedDisorder Not Otherwise Specified (NOS); Amphetamine Abuse; AmphetamineDependence; Amphetamine Intoxication; Amphetamine Intoxication Delirium;Amphetamine Withdrawal; Amphetamine-Induced Anxiety Disorder;Amphetamine-Induced Mood Disorder; Amphetamine-Induced PsychoticDisorder, With Delusions; Amphetamine-Induced Psychotic Disorder, WithHallucinations; Amphetamine-Induced Sexual Dysfunction;Amphetamine-Induced Sleep Disorder; Amphetamine-Related Disorder NOS;Cannabis Abuse; Cannabis Dependence; Cannabis Intoxication; CannabisIntoxication Delirium; Cannabis-Induced Anxiety Disorder;Cannabis-Induced Psychotic Disorder, With Delusions; Cannabis-InducedPsychotic Disorder, With Hallucinations; Cannabis-Related Disorder NOS;Cocaine Abuse; Cocaine Dependence; Cocaine Intoxication; CocaineIntoxication Delirium; Cocaine Withdrawal; Cocaine-Induced AnxietyDisorder; Cocaine-Induced Mood Disorder; Cocaine-Induced PsychoticDisorder, With Delusions; Cocaine-Induced Psychotic Disorder, WithHallucinations; Cocaine-Induced Sexual Dysfunction; Cocaine-InducedSleep Disorder; Cocaine-Related Disorder NOS; Inhalant Abuse; InhalantDependence; Inhalant Intoxication; Inhalant Intoxication Delirium;Inhalant-Induced Anxiety Disorder; Inhalant-Induced Mood Disorder;Inhalant-Induced Persisting Dementia; Inhalant-Induced PsychoticDisorder, With Delusions; Inhalant-Induced Psychotic Disorder, WithHallucinations; Inhalant-Related Disorder NOS; Opioid Abuse; OpioidDependence; Opioid Intoxication; Opioid Intoxication Delirium; OpioidWithdrawal; Opioid-Induced Mood Disorder; Opioid-Induced PsychoticDisorder, With Delusions; Opioid-Induced Psychotic Disorder, WithHallucinations; Opioid-Induced Sexual Dysfunction; Opioid-Induced SleepDisorder; Opioid-Related Disorder NOS; Phencyclidine Abuse;Phencyclidine Dependence; Phencyclidine Intoxication; PhencyclidineIntoxication Delirium; Phencyclidine-Induced Anxiety Disorder;Phencyclidine-Induced Mood Disorder; Phencyclidine-Induced PsychoticDisorder, With Delusions; Phencyclidine-Induced Psychotic Disorder, WithHallucinations; and Phencyclidine-Related Disorder NOS.

The terms “cessation” and “withdrawal” may be, but need not be, inreference to the following conditions characterized in the DSM-IV TR:Nicotine Withdrawal; Nicotine-Related Disorder Not otherwise Specified;Nicotine Dependence, with physiological dependence; Nicotine Dependence,without physiological dependence; Nicotine Dependence, Early FullRemission; Nicotine Dependence, Early Partial Remission; NicotineDependence, Sustained Full Remission; Nicotine Dependence, SustainedPartial Remission; Nicotine Dependence, On Agonist Therapy; OpioidWithdrawal; Opioid-Related Disorder Not Otherwise Specified; OpioidDependence, with physiological dependence; Opioid Dependence, withoutphysiological dependence; Opioid Dependence, Early Full Remission;Opioid Dependence, Early Partial Remission; Opioid Dependence, SustainedFull Remission; Opioid Dependence, Sustained Partial Remission; OpioidDependence On Agonist Therapy; and Opioid Dependence in a controlledenvironment; Ethanol Withdrawal; Ethanol Dependence with PhysiologicalDependence; Ethanol Withdrawal, without Physiological Dependence;Ethanol Withdrawal, Early Full Remission; Ethanol Withdrawal, EarlyPartial Remission; Ethanol Withdrawal, Sustained Full Remission; EthanolWithdrawal, Sustained Partial Remission; Ethanol Withdrawal, on AgonistTherapy; Ethanol Withdrawal, In a Controlled Environment; AmphetamineWithdrawal; and Cocaine Withdrawal.

As used herein, “on agonist therapy” refers to being treated with anagonist for substance abuse, dependence, or withdrawal. The term“agonist” refers to a factor including, but not limited to a chemicalcompound, such as a small molecule or a complex organic compound or aprotein, that triggers a response in a patient that is at least oneresponse or partial response of the substance being abused, dependedupon, or withdrawn from by the patient. For example, in someembodiments, “Opioid Dependence On Agonist Therapy” refers to OpioidDependence on methadone therapy.

Withdrawal symptoms can arise upon reduction of any of a variety ofsubstances. For example, the discontinued use of tobacco products, allof which contain nicotine, typically results in the onset of nicotinewithdrawal conditions. Individuals often suffer the symptoms of nicotinewithdrawal as a consequence of the discontinued use of tobacco in anyform, including, but not limited to smoking of cigarette, cigar, or pipetobacco, or the oral or intranasal ingestion of tobacco or chewingtobacco. Such oral or intranasal tobacco includes, but is not limited tosnuff and chewing tobacco. The cessation of nicotine use or reduction inthe amount of nicotine use, is often followed within 24 hours bysymptoms including dysphoric, depressed mood; light-headedness;insomnia; irritability, frustration or anger; anxiety; nervous tremor;difficulty concentrating; restlessness; decreased heart rate; increasedappetite or weight gain; and the craving for tobacco or nicotine. Thesesymptoms often cause clinically significant distress or impairment insocial, occupational, or other important areas of functioning. Themethods described herein may be used to alleviate one or more symptomsattributed to nicotine withdrawal when such symptoms are not due to ageneral medical condition and are not better accounted for by anothermedical disorder. The present method is also helpful to those who havereplaced, or partially replaced, their use of tobacco with the use ofnicotine replacement therapy. Thus, such patients can be assisted toreduce and even eliminate entirely their dependence on nicotine in allforms.

The discontinuing or reduction in administration of an opioid, typicallyself-administration, through injection or orally, through smoking orintranasal ingestion, often results in the presence of a characteristicopioid withdrawal condition. This withdrawal condition can also beprecipitated by administration of an opioid antagonist such as naloxoneor naltrexone after opioid use. Opioid withdrawal is characterized bysymptoms that are generally opposite to the opioid agonist effects.These withdrawal symptoms may include anxiety; restlessness; muscleaches, often in the back and legs; craving for opioids; irritability andincreased sensitivity to pain; dysphoric mood; nausea or vomiting;lacrimation; rhinorrhoea; papillary dilation; piloerection; sweating;diarrhea; yawning; fever; and insomnia. When dependence is onshort-acting opioids, such as heroin, withdrawal symptoms usually occurwithin 6-24 hours after the last dose, while with longer-acting opioids,such as methadone, symptoms may take 2-4 days to emerge. These symptomsoften cause clinically significant distress or impairment in social,occupational or other important areas of functioning. The methodsdescribed herein can be used to alleviate one or more symptomsattributed to opioid withdrawal when such symptoms are not due to ageneral medical condition and are not better accounted for by anothermedical disorder.

The discontinuing of or reduction in use of ethanol (e.g., ethanolcontaining beverages) results in the onset of ethanol withdrawalconditions. Ethanol withdrawal conditions are characterized by symptomsthat begin when blood concentrations of ethanol decline sharply, within4 to 12 hours after ethanol use has been stopped or reduced. Theseethanol withdrawal symptoms include craving for ethanol; autonomichyperactivity (such as sweating or pulse rate greater than 100); handtremor; insomnia; nausea; vomiting; transient visual, tactile, orauditory hallucinations or illusions; psychomotor agitation; anxiety;and grand mal seizures. These symptoms often cause clinicallysignificant distress or impairment in social, occupational, or otherimportant areas of functioning. The methods described herein may be usedto alleviate one or more symptoms attributed to ethanol withdrawal whensuch symptoms are not due to a general medical condition and are notbetter accounted for by another medical disorder.

Cocaine abuse and dependence can cause cognitive, behavioral, andphysiological symptoms. Symptoms of cocaine abuse and dependence caninclude varying degrees of attention deficit hyperactivity disorder andeuphoria; increased energy, excitement, and sociability; less hunger andfatigue; a marked feeling of physical and mental strength; dysphoria;decreased sensation of pain; and craving for cocaine. Respiratoryeffects include symptoms such as bronchitis, shortness of breath, andchest pain, and cardiovascular effects include symptoms such as heartpalpitations, arrhythmia, cardiomyopathy, and heart attacks. Symptomsalso include dilated pupils, nausea, vomiting, headache, vertigo,anxiety, dizziness, psychosis, and confusion. Administration of cocainethrough snorting or sniffing can result in ear, nose, and throat effectsincluding nasal irritation, nasal crusting, recurrent nosebleeds, nasalstuffiness, and facial pain. In some embodiments, Compound A treatmentreduces at least one symptom of cocaine abuse and dependence in apatient. In some embodiments, nepicstat treatment increases at least onenegative subjective symptom of cocaine abuse and dependence.

Cocaine withdrawal symptoms can include a fatigue, lack of pleasure,depression, irritability, sleep disorders, increased appetite,pyschomotor retardation, agitation, extreme suspicion, and craving forcocaine. In some embodiments, Compound A treatment reduces at least onesymptom of cocaine withdrawal.

Substance dependence can be characterized by the phases: acquisition,maintenance, extinction, and relapse. As used herein, the term“acquisition” refers to a phase of substance dependence in whichdependence on the substance is initiated and acquired by a patient. Insome embodiments, Compound A treatment inhibits the development of theacquisition phase in a patient. In some embodiments, Compound Atreatment of the acquisition phase reduces at least one of the amount orfrequency of substance use by a patient. In some embodiments, Compound Atreatment of the acquisition phase reduces at least one DSM-IV symptomof substance abuse and dependence in a patient. In some embodiments,Compound A treatment of the acquisition phase reduces at least onesymptom of substance abuse and dependence which include by way ofexample and without limitation at least one of euphoria, apathy,irritability, recklessness, poor judgment, compulsion, aggression,anger, craving for the substance being abused or depended upon, and mooddisorders. In some embodiments, treatment with Compound A reduces thesubstance craving induced by a stressful event in a patient during theacquisition phase.

“Maintenance” refers to a phase of substance dependence in which thereis stable administration to or use of the substance by a patient. Insome embodiments, a 10% variance in at least one of the amount andfrequency of substance use by a patient is considered a stable behavior.In some embodiments, Compound A treatment of the maintenance phasereduces at least one of the amount and frequency of substance use by apatient. In some embodiments, Compound A treatment of the maintenancephase reduces at least one DSM-IV symptom of substance abuse anddependence in a patient. In some embodiments, Compound A treatment ofthe maintenance phase reduces at least one symptom of substance abuseand dependence which includes by way of example and without limitationat least one of euphoria, apathy, irritability, recklessness, poorjudgment, compulsion, aggression, anger, craving for the substance beingabused or depended upon, and mood disorders. In some embodiments,treatment with Compound A reduces the substance craving induced by astressful event in a patient during the maintenance phase.

“Extinction” refers to a phase of substance dependence in which thesubstance is not provided to a patient or a patient abstains from use ofthe substance. In some embodiments, the dependence on the substance isextinguished or reduced in the extinction phase. In some embodiments, atleast one withdrawal symptom occurs in the extinction phase. In someembodiments, Compound A treatment promotes the development of theextinction phase in a patient. In some embodiments, Compound A treatmentof the extinction phase reduces at least one DSM-IV symptom of substanceabuse and dependence in a patient. In some embodiments, Compound Atreatment during the extinction phase reduces at least one symptom ofsubstance abuse and dependence which includes by way of example andwithout limitation at least one of euphoria, apathy, irritability,recklessness, poor judgment, compulsion, aggression, anger, craving forthe substance being abused or depended upon, and mood disorders. In someembodiments, Compound A treatment reduces the withdrawal symptoms in apatient in the extinction phase. In some embodiments, treatment withCompound A reduces the substance craving induced by a stressful event ina patient in the extinction phase.

“Relapse” refers to recurrence of at least one symptom of substanceabuse or dependence after a period of abstinence in a patient. In someembodiments, the relapse occurs at the end of remission. In someembodiments, a patient has undergone extinction training prior torelapse. In some embodiments, relapse occurs after drug priming, stress,or exposure to an environment related cue or stimulation that waspreviously associated with substance use. In some embodiments, CompoundA treatment reduces the frequency of relapse in a patient. In someembodiments, Compound A treatment of the relapse phase reduces at leastone DSM-IV symptom of substance abuse and dependence in a patient. Insome embodiments, Compound A treatment of the relapse phase reduces atleast one symptom of substance abuse and dependence which includes byway of example and without limitation at least one of euphoria, apathy,irritability, recklessness, poor judgment, compulsion, aggression,anger, craving for the substance being abused or depended upon, and mooddisorders. In some embodiments, Compound A treatment reduces thewithdrawal symptoms in a patient during the relapse phase. In someembodiments, treatment with Compound A reduces the substance cravinginduced by a stressful event in a patient during the relapse phase.

Treatment of substance abuse, dependence, and withdrawal may beconducted in stages. In some embodiments, an initial period ofabstinence from substance use is preferred before induction of treatmentwith Compound A in a patient. In some embodiments, an initial low doseof Compound A is administered to a patient. In some embodiments, theamount of Compound A administered to a patient is escalated until adesired therapeutic response is observed. In some embodiments, theamount of Compound A is escalated in order to determine the optimal doseto treat the condition while minimizing symptoms, side effects, andcravings for the substance in a patient.

In some embodiments, Compound A treatment promotes remission. In someembodiments, the dose of Compound A is unchanged or tapered off afterremission is reached in a patient.

Provided are methods of treating a patient suffering from or susceptibleto at least one symptom of abuse of, dependence on, or withdrawal fromat least one substance. The methods include administering to the patienta therapeutically effective amount of Compound A. In some embodiments,the at least one substance is selected from a drug of abuse and amedication. In some embodiments, the drug of abuse is selected from apsychostimulant agent, an opioid, a hallucinogen, an inhalant, asedative, a tranquilizer, a hypnotic, an anxiolytic, and an illicitsubstance. In some embodiments, the psychostimulant agent is abeta-phenylisopropylamine derivative. In some embodiments, thebeta-phenylisopropylamine derivative is selected from amphetamine,dextroamphetamine, and methamphetamine. In some embodiments, thepsychostimulant agent is selected from ecstasy, phenmetrazine,methylphenidate, diethylpropion, pemoline, mazindol, (−) cathione, andfenfluramine. In some embodiments, the opioid is selected from Lortab,Tramadol, heroin, methadone, hydrocodone, and oxycodone. In someembodiments, the hallucinogen is selected from psilocybin, ahallucinogenic mushroom, lysergic acid diethylamide (LSD), phencyclidine(PCP), and ketamine. In some embodiments, the inhalant is selected frombenzene, toluene, o-xylene, m-xylene, p-xylene, ethylbenzene,fluorobenzene, o-difluorobenzene, 1,3,5-triflurobenzene,1,2,4-trifluorobenzene, pentafluorotoluene, pentafluorobenzene, andperfluorobenzene. In some embodiments, the medication is selected froman anesthetic, an analgesic, an anticholinergic agent, an antihistamine,a muscle relaxant, a nonsteroidal anti-inflammatory medication, an overthe counter medication, and an antidepressant medication. In someembodiments, the drug of abuse is cocaine, alcohol, caffeine, opium,cannabinoid, cannabis, benzodiazapine carisprodol, tobacco, nicotine,Vicodin, Lorcet, Percocet, Percodan, and Tylox. In some embodiments, thedrug of abuse is cocaine and the Compound A reduces at least one symptomof cocaine abuse and dependence in the patient selected from attentiondeficit hyperactivity disorder; euphoria; increased energy, excitementand sociability; less hunger and fatigue; a marked feeling of physicaland mental strength; decreased sensation of pain; bronchitis; shortnessof breath; chest pain; heart palpitations; arrhythmia; cardiomyopathy;heart attack; dilated pupils; nausea; vomiting; headache; vertigo;dizziness; anxiety; pychosis; confusion; nasal irritation; nasalcrusting; recurrent nosebleeds; nasal stuffiness; facial pain;dysphoria; and craving for cocaine. In some embodiments, the drug ofabuse is cocaine and the Compound A increases at least one negativesubjective symptom of cocaine abuse and dependence. In some embodiments,the drug of abuse is cocaine and the Compound A reduces at least onesymptom of cocaine withdrawal selected from fatigue, lack of pleasure,depression, irritability, sleep disorders, increased appetite,pyschomotor retardation, agitation, extreme suspicion, and craving forcocaine. In some embodiments, the Compound A treatment improves a scoreof the patient on at least one of the attention deficit hyperactivitydisorder IV rating scale (ADHD-IV), Hamilton Depression Scale (HAM-D),Hamilton Anxiety Scale (HAM-A), Beck Depression inventory (BDI), apathyscale from Neuropsychiatric Inventory, and a cognitive function ratingscale. In some embodiments, the cognitive function rating scale isselected from the Wechsler Adult Intelligence Scale-Revised (WAIS-R),Wechsler Memory Scale-Revised (WMS-R), Rey Auditory Verbal Learning Test(RAVLT, Trials I-VII), Rey Complex Figure Test (RCFT), and the TrailMaking Test (TMT, Parts A and B). In some embodiments, the Compound Areduces in the patient at least one of the amount and frequency ofsubstance use by the patient. In some embodiments, the Compound Areduces in the patient at least one symptom of abuse of, dependence on,or withdrawal from the at least one substance. In some embodiments, theCompound A reduces at least one symptom of substance abuse in thepatient selected from recurrent substance use resulting in a failure tofulfill major role obligations at work, school, or home; recurrentsubstance use in situations in which it is physically hazardous;recurrent substance-related legal problems; and continued substance usedespite having persistent or recurrent social or interpersonal problemscaused or exacerbated by the effects of the substance. In someembodiments, the Compound A reduces at least one symptom of substancedependence in the patient selected from tolerance; withdrawal; thesubstance is often taken in larger amounts or over a longer period thenwas intended; there is a persistent desire and/or unsuccessful effortsto cut down or control substance use; a great deal of time is spent inat least one of activities to obtain the substance, use the substance,and recover from its effects; at least one of important social,occupational and recreational activities are given up and/or reducedbecause of substance use; and the substance use is continued despiteknowledge of having a persistent and/or recurrent physical and/orpsychological problem that is likely to have been caused or exacerbatedby the substance. In some embodiments, the Compound A promotes remissionin the patient. In some embodiments, the remission is characterized byat least one of early full remission, early partial remission, sustainedfull remission, and sustained partial remission. In some embodiments,the Compound A prolongs a period of remission in the patient. In someembodiments, the methods further include treatment with at least one ofcontingency management and cognitive behavioral therapy. In someembodiments, the methods further include co-administering atherapeutically effective amount of least one other agent selected froma selective serotonin reuptake inhibitor (SSRI), aserotonin-norepinephrine reuptake inhibitor (SNRI), a norepinephrinereuptake inhibitor (NRI), a norepinephrine-dopamine reuptake inhibitor(NDRI), a serotonin 5-hydroxytryptaminelA (5HT1A) antagonist, a dopamineβ-hydroxylase inhibitor, an adenosine receptor antagonist, an adenosineA2A receptor antagonist, a monoamine oxidase inhibitor (MAOI), amonoamine oxidase B inhibitor, a sodium channel blocker, a calciumchannel blocker, a central and peripheral alpha adrenergic receptorantagonist, a central alpha adrenergic agonist, a central or peripheralbeta adrenergic receptor antagonist, a NK-1 receptor antagonist, acorticotropin releasing factor (CRF) antagonist, an atypicalantidepressant/antipsychotic, a tricyclic, an anticonvulsant, aglutamate antagonist, a gamma-aminobutyric acid (GABA) agonist, a GABAmetabolism enzyme inhibitor, a GABA synthesis activator, a partialdopamine D2 agonist, a dopamine metabolism enzyme inhibitor, acatechol-O-methyl-transferase inhibitor, an opioid receptor antagonist,a mood stabilizer, a direct or indirect dopamine agonist, a partial 5HT1agonist, a serotonin 5HT2 antagonist, an opioid, a carboxylaseinhibitor, a partial opioid agonist, a partial nicotinic agonist, and aninhalant. In some embodiments, the at least one other agent is a SSRIselected from paroxetine, sertraline, citalopram, escitalopram, andfluoxetine. In some embodiments, the at least one other agent is a SNRIselected from duloxetine, mirtazapine, and venlafaxine. In someembodiments, the at least one other agent is a NRI selected frombupropion and atomoxetine. In some embodiments, the at least other agentis the NDRI bupropion. In some embodiments, the at least one other agentis the dopamine β-hydroxylase inhibitor disulfiram. In some embodiments,the at least one other agent is the adenosine A2A receptor antagonististradefylline. In some embodiments, the at least one other agent is asodium channel blocker selected from lamotrigine, carbamazepine,oxcarbazepine, and valproate. In some embodiments, the at least oneother agent is a calcium channel blocker selected from nimodopone,lamotrigine, and carbamazepine. In some embodiments, the at least oneother agent is the central and peripheral alpha adrenergic receptorantagonist prazosin. In some embodiments, the at least one other agentis the central alpha adrenergic agonist clonidine. In some embodiments,the at least one other agent is the central or peripheral betaadrenergic receptor antagonist propranolol. In some embodiments, the atleast one other agent is an atypical antidepressant/antipsychoticselected from bupropion, olanzepine, risperidone, and quetiapine. Insome embodiments, the at least one other agent is a tricyclic selectedfrom amitriptyline, amoxapine, desipramine, doxepin, imipramine,nortriptyline, protiptyline, and trimipramine. In some embodiments, theat least one other agent is an anticonvulsant selected from phenytoin,lamotrigine, carbamazepine, oxcarbazepine, valproate, topiramate,tiagabine, vigabatrin, and levetiracetam. In some embodiments, the atleast one other agent is the glutamate antagonist topiramate. In someembodiments, the at least one other agent is a GABA agonist selectedfrom baclofen, valproate, and topiramate. In some embodiments, the atleast one other agent is the dopamine metabolism enzyme inhibitorcarbidopa. In some embodiments, the at least one other agent is thepartial dopamine D2 agonist aripiprazole. In some embodiments, the atleast one other agent is an opioid receptor antagonist selected fromnaltrexone and naloxone. In some embodiments, the at least one otheragent is a mood stabilizer selected from carbamazepine and lithium. Insome embodiments, the at least one other agent is a direct or indirectdopamine agonist selected from dopamine, bromocriptine, pergolide,amantadine, mazindole, and methylphenidate. In some embodiments, the atleast other agent is the partial 5HT1 agonist gepirone. In someembodiments, the at least other agent is the serotonin 5HT2 antagonistritanserin. In some embodiments, the at least other agent is the opioidmethadone. In some embodiments, the at least other agent is the partialopioid agonist buprenorphine. In some embodiments, the at least otheragent is the partial nicotinic agonist champix. In some embodiments, theat least one other agent is an inhalant selected from benzene, toluene,o-xylene, m-xylene, p-xylene, ethylbenzene, fluorobenzene,o-difluorobenzene, 1,3,5-triflurobenzene, 1,2,4-trifluorobenzene,pentafluorotoluene, pentafluorobenzene, and perfluorobenzene. In someembodiments, the methods further include co-administering atherapeutically effective amount of least one other agent selected frombenzodiazepine, levodopa, carisprodol, modafenil, acamprosate,gamma-butyrolactone, gamma-hydroxybutyrate, opium, psilopcybin,hallucinogenic mushroom, tobacco, and nicotine. In some embodiments, theCompound A is administered to the patient after a period of abstinencefrom substance use by the patient. In some embodiments, thetherapeutically effective amount of Compound A in the patient isdetermined by escalating the amount of Compound A administered to thepatient until a desired therapeutic response is observed. In someembodiments, the amount of Compound A is tapered off after remission isreached in the patient. In some embodiments, the amount of Compound A isunchanged after remission is reached in the patient.

Also provided are methods of treating at least one phase of substancedependence on at least one substance in a patient. In some embodiments,the at least one phase of substance dependence is selected fromacquisition, maintenance, extinction, and relapse. The methods includeadministering to the patient a therapeutically effective amount ofCompound A. In some embodiments, the Compound A inhibits the developmentof the acquisition phase in the patient. In some embodiments, theCompound A promotes the development of the extinction phase in thepatient. In some embodiments, the Compound A reduces the frequency ofrelapse in the patient. In some embodiments, the at least one substanceis selected from a drug of abuse and a medication. In some embodiments,the drug of abuse is selected from a psychostimulant agent, an opioid, ahallucinogen, an inhalant, a sedative, a tranquilizer, a hypnotic, ananxiolytic, and an illicit substance. In some embodiments, thepsychostimulant agent is a beta-phenylisopropylamine derivative. In someembodiments, the beta-phenylisopropylamine derivative is selected fromamphetamine, dextroamphetamine, and methamphetamine. In someembodiments, the psychostimulant agent is selected from ecstasy,phenmetrazine, methylphenidate, diethylpropion, pemoline, mazindol, (−)cathione, and fenfluramine. In some embodiments, the opioid is selectedfrom Lortab, Tramadol, heroin, methadone, hydrocodone, and oxycodone. Insome embodiments, the hallucinogen is selected from psilocybin, ahallucinogenic mushroom, lysergic acid diethylamide (LSD), phencyclidine(PCP), and ketamine. In some embodiments, the inhalant is selected frombenzene, toluene, o-xylene, m-xylene, p-xylene, ethylbenzene,fluorobenzene, o-difluorobenzene, 1,3,5-triflurobenzene,1,2,4-trifluorobenzene, pentafluorotoluene, pentafluorobenzene, andperfluorobenzene. In some embodiments, the medication is selected froman anesthetic, an analgesic, an anticholinergic agent, an antihistamine,a muscle relaxant, a nonsteroidal anti-inflammatory medication, an overthe counter medication, and an antidepressant medication. In someembodiments, the drug of abuse is alcohol, caffeine, opium, cannabinoid,cannabis, benzodiazapine, carisprodol, tobacco, nicotine, Vicodin,Lorcet, Percocet, Percodan, and Tylox. In some embodiments, the CompoundA treatment improves a score of the patient on at least one of theADHD-IV, HAM-D, HAM-A, BDI, apathy scale from NeuropsychiatricInventory, and a cognitive function rating scale. In some embodiments,the cognitive function rating scale is selected from the WAIS-R, WMS-R,RAVLT, Trials I-VII, RCFT, and TMT, Parts A and B. In some embodiments,the Compound A reduces in the patient at least one of the amount andfrequency of use of the at least one substance by the patient. In someembodiments, the Compound A reduces in the patient at least one symptomof abuse of, dependence on, or withdrawal from the at least onesubstance. In some embodiments, the Compound A reduces at least onesymptom of substance abuse in the patient selected from recurrentsubstance use resulting in a failure to fulfill major role obligationsat work, school, or home; recurrent substance use in situations in whichit is physically hazardous; recurrent substance-related legal problems;and continued substance use despite having persistent or recurrentsocial or interpersonal problems caused or exacerbated by the effects ofthe substance. In some embodiments, the Compound A reduces at least onesymptom of substance dependence in the patient selected from tolerance;withdrawal; the substance is often taken in larger amounts or over alonger period then was intended; there is a persistent desire and/orunsuccessful efforts to cut down or control substance use; a great dealof time is spent in at least one of activities to obtain the substance,use the substance, and recover from its effects; at least one ofimportant social, occupational and recreational activities are given upand/or reduced because of substance use; and the substance use iscontinued despite knowledge of having a persistent and/or recurrentphysical and/or psychological problem that is likely to have been causedor exacerbated by the substance. In some embodiments, the Compound Apromotes remission in the patient. In some embodiments, the remission ischaracterized by at least one of early full remission, early partialremission, sustained full remission, and sustained partial remission. Insome embodiments, the Compound A prolongs a period of remission in thepatient. In some embodiments, the methods further include treatment withat least one of contingency management and cognitive behavioral therapy.In some embodiments, the methods further include co-administering atherapeutically effective amount of least one other agent selected froma selective serotonin reuptake inhibitor (SSRI), aserotonin-norepinephrine reuptake inhibitor (SNRI), a norepinephrinereuptake inhibitor (NRI), a norepinephrine-dopamine reuptake inhibitor(NDRI), a serotonin 5-hydroxytryptaminelA (5HT1A) antagonist, a dopamineβ-hydroxylase inhibitor, an adenosine receptor antagonist, an adenosineA2A receptor antagonist, a monoamine oxidase inhibitor (MAOI), amonoamine oxidase B inhibitor, a sodium channel blocker, a calciumchannel blocker, a central and peripheral alpha adrenergic receptorantagonist, a central alpha adrenergic agonist, a central or peripheralbeta adrenergic receptor antagonist, a NK-1 receptor antagonist, acorticotropin releasing factor (CRF) antagonist, an atypicalantidepressant/antipsychotic, a tricyclic, an anticonvulsant, aglutamate antagonist, a gamma-aminobutyric acid (GABA) agonist, a GABAmetabolism enzyme inhibitor, a GABA synthesis activator, a partialdopamine D2 agonist, a dopamine metabolism enzyme inhibitor, acatechol-O-methyl-transferase inhibitor, an opioid receptor antagonist,a mood stabilizer, a direct or indirect dopamine agonist, a partial 5HT1agonist, a serotonin 5HT2 antagonist, an opioid, a carboxylaseinhibitor, a partial opioid agonist, a partial nicotinic agonist, and aninhalant. In some embodiments, the at least one other agent is a SSRIselected from paroxetine, sertraline, citalopram, escitalopram, andfluoxetine. In some embodiments, the at least one other agent is a SNRIselected from duloxetine, mirtazapine, and venlafaxine. In someembodiments, the at least one other agent is a NRI selected frombupropion and atomoxetine. In some embodiments, the at least other agentis the NDRI bupropion. In some embodiments, the at least one other agentis the dopamine β-hydroxylase inhibitor disulfiram. In some embodiments,the at least one other agent is the adenosine A2A receptor antagonististradefylline. In some embodiments, the at least one other agent is asodium channel blocker selected from lamotrigine, carbamazepine,oxcarbazepine, and valproate. In some embodiments, the at least oneother agent is a calcium channel blocker selected from nimodopone,lamotrigine, and carbamazepine. In some embodiments, the at least oneother agent is the central and peripheral alpha adrenergic receptorantagonist prazosin. In some embodiments, the at least one other agentis the central alpha adrenergic agonist clonidine. In some embodiments,the at least one other agent is the central or peripheral betaadrenergic receptor antagonist propranolol. In some embodiments, the atleast one other agent is an atypical antidepressant/antipsychoticselected from bupropion, olanzepine, risperidone, and quetiapine. Insome embodiments, the at least one other agent is a tricyclic selectedfrom amitriptyline, amoxapine, desipramine, doxepin, imipramine,nortriptyline, protiptyline, and trimipramine. In some embodiments, theat least one other agent is an anticonvulsant selected from phenytoin,lamotrigine, carbamazepine, oxcarbazepine, valproate, topiramate,tiagabine, vigabatrin, and levetiracetam. In some embodiments, the atleast one other agent is the glutamate antagonist topiramate. In someembodiments, the at least one other agent is a GABA agonist selectedfrom baclofen, valproate, and topiramate. In some embodiments, the atleast one other agent is the dopamine metabolism enzyme inhibitorcarbidopa. In some embodiments, the at least one other agent is thepartial dopamine D2 agonist aripiprazole. In some embodiments, the atleast one other agent is an opioid receptor antagonist selected fromnaltrexone and naloxone. In some embodiments, the at least one otheragent is a mood stabilizer selected from carbamazepine and lithium. Insome embodiments, the at least one other agent is a direct or indirectdopamine agonist selected from dopamine, bromocriptine, pergolide,amantadine, mazindole, and methylphenidate. In some embodiments, the atleast other agent is the partial 5HT1 agonist gepirone. In someembodiments, the at least other agent is the serotonin 5HT2 antagonistritanserin. In some embodiments, the at least other agent is the opioidmethadone. In some embodiments, the at least other agent is the partialopioid agonist buprenorphine. In some embodiments, the at least otheragent is the partial nicotinic agonist champix. In some embodiments, theat least one other agent is an inhalant selected from benzene, toluene,o-xylene, m-xylene, p-xylene, ethylbenzene, fluorobenzene,o-difluorobenzene, 1,3,5-triflurobenzene, 1,2,4-trifluorobenzene,pentafluorotoluene, pentafluorobenzene, and perfluorobenzene. In someembodiments, the methods further include co-administering atherapeutically effective amount of least one other agent selected frombenzodiazepine, levodopa, carisprodol, modafenil, acamprosate,gamma-butyrolactone, gamma-hydroxybutyrate, opium, psilopcybin,hallucinogenic mushroom, tobacco, and nicotine. In some embodiments, theCompound A is administered to the patient after a period of abstinencefrom substance use by the patient. In some embodiments, thetherapeutically effective amount of Compound A in the patient isdetermined by escalating the amount of Compound A administered to thepatient until a desired therapeutic response is observed. In someembodiments, the amount of Compound A is tapered off after remission isreached in the patient. In some embodiments, the amount of Compound A isunchanged after remission is reached in the patient.

Also provided are methods of treating at least one phase of cocainedependence in a patient. In some embodiments, the at least one phase isselected from acquisition, maintenance, extinction, and relapse. Themethods include administering to the patient a therapeutically effectiveamount of Compound A. In some embodiments, the Compound A inhibits thedevelopment of the acquisition phase in the patient. In someembodiments, the Compound A promotes development of the extinction phasein the patient. In some embodiments, the Compound A reduces thefrequency of relapse in the patient. In some embodiments, the Compound Areduces in the patient at least one symptom of abuse of, dependence on,or withdrawal from cocaine. In some embodiments, the Compound A reducesat least one symptom of cocaine abuse in the patient selected fromrecurrent cocaine use resulting in a failure to fulfill major roleobligations at work, school, or home; recurrent cocaine use insituations in which it is physically hazardous; recurrentcocaine-related legal problems; and continued cocaine use despite havingpersistent or recurrent social or interpersonal problems caused orexacerbated by the effects of the cocaine. In some embodiments, theCompound A reduces at least one symptom of cocaine dependence in thepatient selected from tolerance; withdrawal; the cocaine is often takenin larger amounts or over a longer period then was intended; there is apersistent desire or unsuccessful efforts to cut down or control cocaineuse; a great deal of time is spent in activities to obtain the cocaine,use the cocaine, or recover from its effects; important social,occupational or recreational activities are given up or reduced becauseof cocaine use; and the cocaine use is continued despite knowledge ofhaving a persistent or recurrent physical or psychological problem thatis likely to have been caused or exacerbated by the cocaine. In someembodiments, the Compound A reduces at least one symptom of cocaineabuse and dependence selected from attention deficit hyperactivitydisorder; euphoria; increased energy, excitement and sociability; lesshunger and fatigue; a marked feeling of physical and mental strength;decreased sensation of pain; bronchitis; shortness of breath; chestpain; heart palpitations; arrhythmia; cardiomyopathy; heart attack;dilated pupils; nausea; vomiting; headache; vertigo; dizziness; anxiety;pychosis; confusion; nasal irritation; nasal crusting; recurrentnosebleeds; nasal stuffiness; facial pain; dysphoria; and craving forcocaine. In some embodiments, the Compound A increases at least onenegative subjective symptom of cocaine abuse and dependence. In someembodiments, the Compound A reduces at least one symptom of cocainewithdrawal selected from fatigue, lack of pleasure, depression,irritability, sleep disorders, increased appetite, pyschomotorretardation, agitation, extreme suspicion, and craving for cocaine. Insome embodiments, the Compound A improves a score of the patient on atleast one of ADHD-IV, HAM-D, HAM-A, BDI, apathy scale fromNeuropsychiatric Inventory, and a cognitive function rating scale. Insome embodiments, the cognitive function rating scale is selected fromWAIS-R, WMS-R, RAVLT, Trials I-VII, RCFT, and TMT, Parts A and B. Insome embodiments, the Compound A reduces at least one of the amount andfrequency of cocaine use by the patient. In some embodiments, theCompound A promotes remission in the patient. In some embodiments, theremission is characterized by at least one of early full remission,early partial remission, sustained full remission, and sustained partialremission. In some embodiments, the Compound A prolongs a period ofremission in the patient. In some embodiments, the methods furtherinclude treatment with at least one of contingency management andcognitive behavioral therapy. In some embodiments, the methods furtherinclude co-administering a therapeutically effective amount of least oneother agent selected from a selective serotonin reuptake inhibitor(SSRI), a serotonin-norepinephrine reuptake inhibitor (SNRI), anorepinephrine reuptake inhibitor (NRI), a norepinephrine-dopaminereuptake inhibitor (NDRI), a serotonin 5-hydroxytryptaminelA (5HT1A)antagonist, a dopamine β-hydroxylase inhibitor, an adenosine receptorantagonist, an adenosine A2A receptor antagonist, a monoamine oxidaseinhibitor (MAOI), a monoamine oxidase B inhibitor, a sodium channelblocker, a calcium channel blocker, a central and peripheral alphaadrenergic receptor antagonist, a central alpha adrenergic agonist, acentral or peripheral beta adrenergic receptor antagonist, a NK-1receptor antagonist, a corticotropin releasing factor (CRF) antagonist,an atypical antidepressant/antipsychotic, a tricyclic, ananticonvulsant, a glutamate antagonist, a gamma-aminobutyric acid (GABA)agonist, a GABA metabolism enzyme inhibitor, a GABA synthesis activator,a partial dopamine D2 agonist, a dopamine metabolism enzyme inhibitor, acatechol-O-methyl-transferase inhibitor, an opioid receptor antagonist,a mood stabilizer, a direct or indirect dopamine agonist, a partial 5HT1agonist, a serotonin 5HT2 antagonist, an opioid, a carboxylaseinhibitor, a partial opioid agonist, a partial nicotinic agonist, and aninhalant. In some embodiments, the at least one other agent is a SSRIselected from paroxetine, sertraline, citalopram, escitalopram, andfluoxetine. In some embodiments, the at least one other agent is a SNRIselected from duloxetine, mirtazapine, and venlafaxine. In someembodiments, the at least one other agent is a NRI selected frombupropion and atomoxetine. In some embodiments, the at least other agentis the NDRI bupropion. In some embodiments, the at least one other agentis the dopamine β-hydroxylase inhibitor disulfiram. In some embodiments,the at least one other agent is the adenosine A2A receptor antagonististradefylline. In some embodiments, the at least one other agent is asodium channel blocker selected from lamotrigine, carbamazepine,oxcarbazepine, and valproate. In some embodiments, the at least oneother agent is a calcium channel blocker selected from nimodopone,lamotrigine, and carbamazepine. In some embodiments, the at least oneother agent is the central and peripheral alpha adrenergic receptorantagonist prazosin. In some embodiments, the at least one other agentis the central alpha adrenergic agonist clonidine. In some embodiments,the at least one other agent is the central or peripheral betaadrenergic receptor antagonist propranolol. In some embodiments, the atleast one other agent is an atypical antidepressant/antipsychoticselected from bupropion, olanzepine, risperidone, and quetiapine. Insome embodiments, the at least one other agent is a tricyclic selectedfrom amitriptyline, amoxapine, desipramine, doxepin, imipramine,nortriptyline, protiptyline, and trimipramine. In some embodiments, theat least one other agent is an anticonvulsant selected from phenytoin,lamotrigine, carbamazepine, oxcarbazepine, valproate, topiramate,tiagabine, vigabatrin, and levetiracetam. In some embodiments, the atleast one other agent is the glutamate antagonist topiramate. In someembodiments, the at least one other agent is a GABA agonist selectedfrom baclofen, valproate, and topiramate. In some embodiments, the atleast one other agent is the dopamine metabolism enzyme inhibitorcarbidopa. In some embodiments, the at least one other agent is thepartial dopamine D2 agonist aripiprazole. In some embodiments, the atleast one other agent is an opioid receptor antagonist selected fromnaltrexone and naloxone. In some embodiments, the at least one otheragent is a mood stabilizer selected from carbamazepine and lithium. Insome embodiments, the at least one other agent is a direct or indirectdopamine agonist selected from dopamine, bromocriptine, pergolide,amantadine, mazindole, and methylphenidate. In some embodiments, the atleast other agent is the partial 5HT1 agonist gepirone. In someembodiments, the at least other agent is the serotonin 5HT2 antagonistritanserin. In some embodiments, the at least other agent is the opioidmethadone. In some embodiments, the at least other agent is the partialopioid agonist buprenorphine. In some embodiments, the at least otheragent is the partial nicotinic agonist champix. In some embodiments, theat least one other agent is an inhalant selected from benzene, toluene,o-xylene, m-xylene, p-xylene, ethylbenzene, fluorobenzene,o-difluorobenzene, 1,3,5-triflurobenzene, 1,2,4-trifluorobenzene,pentafluorotoluene, pentafluorobenzene, and perfluorobenzene. In someembodiments, the methods further include co-administering atherapeutically effective amount of least one other agent selected frombenzodiazepine, levodopa, carisprodol, modafenil, acamprosate,gamma-butyrolactone, gamma-hydroxybutyrate, opium, psilopcybin,hallucinogenic mushroom, tobacco, and nicotine. In some embodiments, theCompound A is administered to the patient after a period of abstinencefrom cocaine use by the patient. In some embodiments, thetherapeutically effective amount of Compound A in the patient isdetermined by escalating the amount of Compound A administered to thepatient until a desired therapeutic response is observed. In someembodiments, the amount of Compound A is tapered off after remissionfrom cocaine dependence is reached in the patient. In some embodiments,the amount of Compound A is unchanged after remission from cocainedependence is reached in the patient. In some embodiments, the CompoundA treats at least one symptom of abuse of, dependence on, or withdrawalfrom at least one secondary substance in the patient. In someembodiments, the at least one secondary substance is selected from adrug of abuse and a medication. In some embodiments, the drug of abuseis selected from a psychostimulant agent, an opioid, a hallucinogen, aninhalant, a sedative, a tranquilizer, a hypnotic, an anxiolytic, and anillicit substance. In some embodiments, the psychostimulant agent is abeta-phenylisopropylamine derivative. In some embodiments, thebeta-phenylisopropylamine derivative is selected from amphetamine,dextroamphetamine, and methamphetamine. In some embodiments, thepsychostimulant agent is selected from ecstasy, phenmetrazine,methylphenidate, diethylpropion, pemoline, mazindol, (−) cathione, andfenfluramine. In some embodiments, the opioid is selected from Lortab,Tramadol, heroin, methadone, hydrocodone, and oxycodone. In someembodiments, the hallucinogen is selected from psilocybin, ahallucinogenic mushroom, lysergic acid diethylamide (LSD), phencyclidine(PCP), and ketamine. In some embodiments, the inhalant is selected frombenzene, toluene, o-xylene, m-xylene, p-xylene, ethylbenzene,fluorobenzene, o-difluorobenzene, 1,3,5-triflurobenzene,1,2,4-trifluorobenzene, pentafluorotoluene, pentafluorobenzene, andperfluorobenzene. In some embodiments, the medication is selected froman anesthetic, an analgesic, an anticholinergic agent, an antihistamine,a muscle relaxant, a nonsteroidal anti-inflammatory medication, an overthe counter medication, and an antidepressant medication. In someembodiments, the drug of abuse is alcohol, caffeine, opium, cannabinoid,cannabis, benzodiazapine, carisprodol, tobacco, nicotine, Vicodin,Lorcet, Percocet, Percodan, and Tylox.

Pharmaceutically acceptable derivatives include acids, bases, enolethers, and esters, esters, hydrates, solvates, and prodrug forms. Thederivative is selected such that its pharmokinetic properties aresuperior with respect to at least one characteristic to thecorresponding neutral agent. The Compound A may be derivatized prior toformulation.

A therapeutically effective amount of Compound A or a pharmaceuticallyacceptable derivative may vary widely depending on the severity of theaddiction or dependence, the age and relative health of the subject, thepotency of the compound used and other factors. In certain embodiments atherapeutically effective amount is from about 0.1 milligram per kg(mg/kg) body weight per day to about 50 mg/kg body weight per day. Inother embodiments the amount is about 1.0 to about 10 mg/kg/day.Therefore, in certain embodiments a therapeutically effective amount fora 70 kg human is from about 7.0 to about 3500 mg/day, while in otherembodiments it is about 70 to about 700 mg/day.

One of ordinary skill in the art of treating such diseases will be ableto ascertain a therapeutically effective amount of Compound A fortreatment or prevention of addiction or dependence without undueexperimentation and in reliance upon personal knowledge and thedisclosure of this application. In general, by way of example andwithout limitation, Compound A will be administered as pharmaceuticalcompositions by one of the following routes: oral, systemic (e.g.,transdermal, intranasal or by suppository) or parenteral (e.g.,intramuscular, intravenous or subcutaneous). Compositions can, by way ofexample and without limitation, take the form of tablets, pills,capsules, semisolids, powders, sustained release formulations,solutions, suspensions, elixirs, aerosols, or any other appropriatecomposition and are comprised of, in general, Compound A in combinationwith at least one pharmaceutically acceptable excipient. Acceptableexcipients are, by way of example and without limitation, non-toxic, aidadministration, and do not adversely affect the therapeutic benefit ofthe compound. Such excipient may be, for example, any solid, liquid,semisolid or, in the case of an aerosol composition, gaseous excipientthat is generally available to one of skill in the art.

Solid pharmaceutical excipients include by way of example and withoutlimitation starch, cellulose, talc, glucose, lactose, sucrose, gelatin,malt, rice, flour, chalk, silica gel, magnesium stearate, sodiumstearate, glycerol monostearate, sodium chloride, dried skim milk, andthe like. Liquid and semisolid excipients may be selected from forexample and without limitation water, ethanol, glycerol, propyleneglycol and various oils, including those of petroleum, animal, vegetableor synthetic origin (e.g., peanut oil, soybean oil, mineral oil, sesameoil, etc.). Preferred liquid carriers, particularly for injectablesolutions, include by way of example and without limitation water,saline, aqueous dextrose and glycols. Compressed gases may be used todisperse the compound in aerosol form. Inert gases suitable for thispurpose are by way of example and without limitation nitrogen, carbondioxide, nitrous oxide, etc.

The pharmaceutical preparations can by way of example and withoutlimitation, moreover, contain preservatives, solubilizers, stabilizers,wetting agents, emulsifiers, sweeteners, colorants, flavorants, saltsfor varying the osmotic pressure, buffers, masking agents orantioxidants. In certain embodiments, they can contain still othertherapeutically valuable substances. Other suitable pharmaceuticalcarriers and their formulations are described in A. R. AlfonsoRemington's Pharmaceutical Sciences 1985, 17th ed. Easton, Pa.: MackPublishing Company.

The amount of Compound A in the composition may vary widely dependingfor example, upon the type of formulation, size of a unit dosage, kindof excipients and other factors known to those of skill in the art ofpharmaceutical sciences. In general, the final composition will comprisefrom 10% w to 90% w of the compound, preferably 25% w to 75% w, with theremainder being the excipient or excipients. Preferably thepharmaceutical composition is administered in a single unit dosage formfor continuous treatment or in a single unit dosage form ad libitum whenrelief of symptoms is specifically required.

EXAMPLES Example 1

Following oral administration of [¹⁴C]-nepicastat, the majority of theradioactivity in plasma was associated with nepicastat, an N-linkedglucuronide of nepicastat (Metabolite 2, M2), and an unidentified polarfraction (M1). There was no significant accumulation of nepicastat withmultiple dosing and T_(1/2) was similar after single and multiple doses.T_(1/2) was 10-14 hours. No significant differences in the C_(max) orAUC for nepicastat were noted between subjects with the fast acetylatorphenotype and those with the slow acetylator phenotype, although C_(max)and AUC for the N-acetyl metabolite were, as expected, much lower in theslow acetylators than in the fast acetylators. In a study comparing thepharmacokinetics of a 40 mg tablet taken while fasting or after a meal,there was no significant difference in the plasma concentrations. T_(ax)was increased to 3.5 hours after a meal from 1.4 hours in the fastedstate.

The pharmacokinetics of nepicastat after a single 40 mg dose wascompared in men and women. The AUC in women was approximately 43%greater than in men and the C_(max) approximately 23% greater in womenthan in men. The T_(1/2) was longer in women than in men. Comparing thepharmacokinetics of nepicastat following 10 days of dosing with a 40 mgdose, the AUC was higher in healthy subjects than in patients with CHEF,with no difference in the T_(1/2). There was no significant accumulationwith multiple dosing in either population.

In humans, compound-related radioactivity is rapidly eliminated. Onaverage, 87.4% of the administered radiolabel was recovered in the first72 hours with 82.4% in the urine and 5.01% in the feces. After 10 days,the mean total recovery of the radiolabel was 93.8%. In plasma, theT_(ax), for the radioactivity was 1-2 hours (similar to that fornepicastat). In both rapid and slow acetylators, an N-linked glucuronideof nepicastat accounted for the greatest percentage of the totalradioactivity in plasma (26.8%) and urine (57.9%) over 0 to 48 hours.The terminal T_(1/2) for total radioactivity in plasma was found to bevery long (˜100 hours), most likely due to a polar fraction present inlow concentrations that was slowly eliminated.

Example 2

In a study designed to assess the effects of nepicastat on cognitivefunction, subjects treated with 5 or 40 mg of nepicastat demonstrated nosignificant impairment of mood, sleep, or cognition. In studies ofthyroid uptake of ¹²³I, doses of 5, 40, and 100 mg of nepicastatdemonstrated no differences from placebo. Reduction of uptake after asingle 200 mg dose of nepicastat was significantly greater than placebo,but significantly less than that following a 10 mg dose of methimazole.In single-dose Phase I studies, doses from 5 to 800 mg (dose calculationbased on the hydrochloride salt) of nepicastat were generally welltolerated in healthy men.

Example 3

In a multiple-dose Phase I study of nepicastat, doses of 5 and 40 mgwere generally well tolerated in healthy men.

Five of the 6 subjects treated for 8 days or longer with 200 mgdeveloped a rash which resolved spontaneously.

One subject developed atrial arrhythmias and intermittent right bundlebranch block after 6 days of dosing with 200 mg of nepicastat.

Example 4

Sixteen non-treatment-seeking cocaine-dependent volunteers are studiedas inpatients using a double-blind, placebo-controlled, within-subjectsdesign. After giving informed consent, potential volunteers completeoutpatient psychiatric and medical screening. Eligible volunteers areadmitted and a physical examination, EKG, pregnancy testing andpsychiatric testing are completed. The study utilizes a dose-escalationdesign in which participants (n=12) receive ascending doses of cocaine(0 mg, 10 mg, 20 mg, and 40 mg) during daily treatment with ascendingdoses of nepicastat (0 mg, 80 mg, 160 mg). A parallel group ofparticipants (n=4) receive only daily treatment with placebo for theduration of the study in order to maintain the blind. Treatment at eachdose level are daily for 4 days, or well over 4 half-lives ofnepicastat, which is 10 to 14 hours. On the 4^(th) day of treatment ateach dose level, participants receive cocaine 0 mg, 10 mg, 20 mg, and 40mg in that order. Cocaine is administered at hourly intervals, providingsufficient time for both the cardiovascular and subjective effects toreturn to baseline. Cardiovascular indices are carefully monitored usingcontinuous EKG and frequent blood pressure during all proceduresinvolving the administration of cocaine, and stopping parameters are inplace so that cocaine is not be administered if cardiovascular indicesexceed preset limits. Previous studies have shown that 6 doses of 32 mgcocaine given at 14-minute intervals is safe, and extending theinter-dose interval to 1 hour may enhance safety further. Blood samplesare collected for analysis of the pharmacokinetics of 10 mg cocaineadministered on the 3^(rd) day of treatment with 0 mg nepicastat andagain on the 3_(rd) day of treatment with 80 mg and 160 mg nepicastat.The effects of nepicastat on the pharmacokinetics of cocaine arestudied. Based on existing information, no interaction is expected.

About 12 days are required for each participant to complete the study.The 16 participants may complete the study within one year.

In order to participate in the study, participants must:

-   -   1. Be English-speaking volunteers who are not seeking treatment        at the time of the study;    -   2. Be between 18-55 years of age;    -   3. Meet DSM-IV TR criteria for cocaine dependence;    -   4. Have a self-reported history of using cocaine by the IV route        and provide at least one cocaine-positive urine prior to        admission;    -   5. Have vital signs as follows: resting pulse between 50 and 95        bpm, blood pressures between 85-150 mm Hg systolic and 45-96 mm        Hg diastolic; this criterion must be met within 2 days of        admission;    -   6. Have hematology and chemistry laboratory tests that are        within normal (+/−10%) limits with the following exceptions: a)        liver function tests (total bilirubin, ALT, AST, and alkaline        phosphatase)≤3× the upper limit of normal, and b) kidney        function tests (creatinine and BUN)≤2× the upper limit of        normal;    -   7. Have a baseline EKG that demonstrates clinically normal sinus        rhythm, clinically normal conduction, and no clinically        significant arrhythmias;    -   8. Have a medical history and brief physical examination        demonstrating no clinically significant contraindications for        study participation, in the judgment of the admitting physician        and the principal investigator.

Potential participants are excluded from participation in the study ifany of the following apply:

-   -   1. Have any history or evidence suggestive of seizure disorder        or brain injury;    -   2. Have any previous medically adverse reaction to cocaine,        including loss of consciousness, chest pain, or epileptic        seizure;    -   3. Have neurological or psychiatric disorders, such as:        -   psychosis, bipolar illness or major depression as assessed            by SCID;        -   organic brain disease or dementia assessed by clinical            interview;        -   history of any psychiatric disorder which would require            ongoing treatment or which would make study compliance            difficult;        -   history of suicide attempts within the past three months            assessed by SCID and/or current suicidal ideation/plan as            assessed by SCID;    -   4. Have evidence of clinically significant heart disease or        hypertension, as determined by the PI, though participants may        be taking antihypertensive medication;    -   5. Have a family history in first-degree relatives of early        cardiovascular morbidity or mortality, as determined by the PI;    -   6. Have evidence of untreated or unstable medical illness        including: neuroendocrine, autoimmune, renal, hepatic, or active        infectious disease;    -   7. Have HIV and are currently symptomatic, have a diagnosis of        AIDS, or are receiving antiretroviral medication;    -   8. Be pregnant or nursing. Other females must either be unable        to conceive (i.e., surgically sterilized, sterile, or        post-menopausal) or be using a reliable form of contraception        (e.g., abstinence, birth control pills, intrauterine device,        condoms, or spermicide). All females must provide negative        pregnancy urine tests before study entry, upon hospital        admission, and at the end of study participation;    -   9. Have asthma or currently use alpha or beta agonists,        theophylline, or other sympathomimetics;    -   10. Have any other illness, condition, or use of psychotropic        medications, which in the opinion of the PI and/or the admitting        physician would preclude safe and/or successful completion of        the study.

Criteria for Discontinuation Following Initiation

-   -   11. Positive urine drug screen or breath test indicating illicit        use of cocaine, cocaine, alcohol, opiates, or other abused drugs        not delivered as part of this protocol;    -   12. Inability to comply with study procedures;    -   13. Meet discontinuation criteria due to exaggerated response to        cocaine, described below.

Stopping Criteria

Participants must continue to meet inclusion criteria in order to remainin the protocol. Cocaine administration is not initiated if there areclinically significant arrhythmias or if vital signs are outside ofacceptable ranges: resting pulse <130 bpm and blood pressure below 165mm Hg systolic and 100 mm Hg diastolic. These values are higher thanthose of the inclusion/exclusion criteria because transient increases invital signs can occur in expectation of receiving cocaine. In addition,repeated doses of cocaine are not administered (and the study physicianhalts continued cocaine delivery) if there are behavioral manifestationsof cocaine toxicity (agitation, psychosis, inability to cooperate withstudy procedures).

Stopping Criteria for Further Participation

Subject participation is terminated if any of the following eventsoccur:

-   -   1. Systolic BP>180 mm Hg sustained for 5 minutes or more;    -   2. Diastolic BP>120 mm Hg sustained for 5 minutes or more;    -   3. Heart rate>(220−age×0.85) bpm sustained for 5 minutes or        more.

Rationale for Subject Selection Criteria

Participants are required to have used cocaine by the IV route to avoidexposing participants to routes of administration that produce moreintensive interoceptive effects. The age criteria were selectedprimarily to avoid enrolling participants with undiagnosedcardiovascular disease. Participants with active HIV disease areexcluded to avoid potential exacerbation of their underlying disease;participants with asymptomatic HIV are included because this group is athigh risk for cocaine dependence. Participants with asthma (or who takeasthma medications) are excluded due to potential adverse interactionsbetween beta agonist medications and cocaine.

Study Medications

Cocaine produces prototypical stimulant effects by inhibiting the uptakeof DA, NE, and serotonin into presynaptic storage granules. Cocaine hasa short elimination half-life, about 90 min. The principal clinicaleffects of cocaine are psychomotor activation and increases insympathetic tone, evident as increases in heart rate and blood pressure.

Cocaine is administered at up to 40 mg in single doses and up to 200 mgin self-administration sessions consisting of 10 doses of 20 mgadministered at 13 min intervals. These doses are modest compared toamounts that participants in these studies have reported using daily;typical daily dosing patterns are on average 250 mg to 500 mg or more.

Doses much higher than those proposed here have been associated withseizures and with severe cardiovascular toxicity and death. Thesepotential toxicities are ameliorated by the use of relatively low doses,careful screening of potential volunteers, by careful monitoring ofparticipants following administration of cocaine, and by the readyavailability of medical intervention in the case of an adverse event.

Cocaine is administered IV, so availability is complete. Cocaine ismetabolized primarily to benzoylecgonine by plasma esterases that arenot known to be affected by nepicastat. Benzyoleconine and other minormetabolites are excreted renally.

Cocaine for IV use in humans is obtained from a NIDA contractor and aletter of authorization to allow us to reference NIDA's IND for cocaineis obtained and submitted to the FDA.

Ascending doses of nepicastat (0 mg, 80 mg, and 160 mg) are administeredat 7 AM. Treatment at each dose level is continued for 4 days.

By starting at a lower dose and increasing the dose after completing thefirst series of study procedures, the risks of the combination ofnepicastat and cocaine are be minimized. This approach also may reducethe risk for rash, which occurred in 7% to 20% of volunteers thus far.Rash incidence was associated with dose and treatment duration. Dosesabove 160 mg conferred a greater risk for rash.

No pharmacokinetic interactions are expected because nepicastat is notan enzyme inhibitor, though pharmacokinetic assessment of the 10 mg doseof cocaine administered on the 3rd day of treatment at each dose levelof nepicastat can confirm this. Because nepicastat reduces the synthesisof NE, the rewarding effects of cocaine may be lower during treatmentwith nepicastat. Because nepicastat increases plasma and brainconcentrations of DA, DA-mediated side effects such as paranoia mayoccur. These symptoms were not observed during the trials for CHF, butstimulants were not administered in those studies.

Following consent, participants are required to submit acocaine-positive urine sample for documentation of ongoing drug use.Some participants (limited by the number of devices available) are alsoasked to wear a telemetry device during screening and throughout thestudy that records heart rate and movement. Data from this device canidentify drug use episodes based on changes in these parameters.

To control nicotine exposure, smoking is prohibited within 2 hours ofstudy procedures involving cocaine administration or cue exposure.Participants are required to refrain from illicit and prescription druguse for the duration of the study and this is confirmed with daily urineand breath alcohol level testing.

Experimental sessions are conducted at approximately the same time ofday for a given participant. Cocaine is administered in an experimentalroom. Cocaine is administered using a syringe pump, which administersthe correct dose of cocaine or saline placebo over 2 minutes. During andfor 1 hour after drug administration sessions heart rate and bloodpressure are monitored.

Participants undergo a targeted history and physical examination. Bloodis drawn for standard laboratory examination, including CBC,electrolytes, LFT, and creatinine. HIV screening is performed as aservice to participants and those testing positive are counseled andreferred for treatment.

The Actiheart MiniMitter is used to measure heart rate and movementprior to admission in some volunteers (the number is limited by thenumber of devices available). The MiniMitter attaches to theparticipants' skin using paste and non-invasively records EKG andmovement for up to two weeks. The data can be downloaded to a PC foranalysis later.

Participants must meet DSM-IV-TR criteria for cocaine and nicotinedependence, determined by the Mini International NeuropsychiatricInterview (MINI) and defined by inclusion/exclusion criteria. The MINIis a short, structured diagnostic interview developed in 1990 bypsychiatrists and clinicians in the United States and Europe for DSM-IVTR and ICD-10 psychiatric disorders. The MINI is the structuredpsychiatric interview of choice for psychiatric evaluation and outcometracking in clinical psychopharmacology trials and epidemiologicalstudies, and is the most widely used psychiatric structured diagnosticinterview instrument in the world. This instrument can be used todetermine whether the subject met DSM-IV TR criteria for drug dependenceand to rule out any major psychiatric disorders (e.g., affectivedisorders, schizophrenia).

The Addiction Severity Index-Lite Clinical Factors (ASI-Lite CF) versionis administered by a trained research staff member during screening. TheASI-Lite is the interviewer's estimate of the severity of theparticipant's status in seven areas (medical, employment, drug use,alcohol use, legal, family/social, and psychological). The Lite versionis a shorter version of the ASI that still retains all questions used tocalculate the ASI composite scores. The family history section of theASI, as the ASI-Lite version collects minimal family historyinformation, are retained.

There is a third-generation Beck Depression Inventory (BDI), revised in1996. The instrument retains its original 21-item questionnaire formatthat requires approximately 10 minutes to complete. The BDI-II has beenvalidated against the BDI-IA and continues to be an excellent index ofdepression/distress. This indicator is used to monitor participants whobecome clinically depressed during the trial, making it also a measurefor participants' safety.

Current attention deficit hyperactivity disorder (ADHD) symptoms areassessed weekly, using the ADHD-IV rating scale.

The apathy scale from the Neuropsychiatric Inventory are collected atbaseline.

DNA is collected with buccal swabs applied to Whatman FTA cards. Thesecards allow safe and stable storage of biological samples for DNAextraction. The anticipated yield of genomic DNA is 50-100 μg, which isadequate for over 500 genotype assays using currently available methods.

Genotypes are determined using 5′ Exonuclease-based (Tagman) genotypingassays. Assays are developed by Applied Biosystems (ABI; Assays byDesign). Allele discrimination are performed using the ABI 3730 realtimePCR cycler.

Blood samples for analysis of the pharmacokinetics of cocaine arecollected during treatment with 0 mg nepicastat (study day 1) and duringtreatment with 80 mg and 160 mg nepicastat (study days 4 and 8). Bloodsamples are collected at −15, 20, 30, 40, 50, 60, 90, 120, 180, 240,300, 360, 420 and 480 minutes following dosing of 10 mg cocaine on the3^(rd) day of treatment with each dose level of nepicastat. Note thatother doses of cocaine (0-40 mg) are administered on the 4^(th) day oftreatment with each dose level of nepicastat, so the pharmacokineticassessment does not interfere with the other assessments. Blood iscollected and plasma separated and frozen at −70° C. until analyzed.Cocaine and BE are assayed using liquid chromatography/tandem massspectrometry (LC/MS/MS). The reference lab has a limit of quantificationof 2.5 ng/ml for these assays. The pharmacokinetic analysis clarifieseffects of nepicastat on the pharmacokinetics of cocaine.

DBH is stored in NE storage granules and is released along with NE.Plasma DBH thus gives a good index of enzymatic activity within the CNS.Blood is sampled daily at 10 AM (prior to cocaine/placebo dosing) andstored for subsequent analysis. DBH activity is measured by using thetyramine-octopamine method using a high performance liquidchromatographic-fluorometric system, as described previously. Thisallows examination of changes in DBH over time, providing an insightinto the pharmacodynamics of nepicastat's inhibition of DBH. The BDI isadministered repeatedly throughout the protocol to monitor changes inmood.

Subjective effects are measured using a computerized visual analoguescale (VAS) consisting of a continuous 10 cm line digitized for scoringpurposes from 0 to 100. Participants are required to move the cursorfrom off the left-hand extreme and onto the line by depressing the leftor right mouse buttons for left and right movements on the line. The VASis designed to provide rapidly acquired ratings of cocaine euphoria,dysphoria and craving. These include ratings of “Any Drug Effect,”“High,” “Good Effects,” “Stimulated,” and “Bad Effects,” “FeelParanoid,” “Feel Suspicious,” and “Would Use Cocaine if Available,”“Crave Cocaine,” “Could Refuse Cocaine Now,” and “Desire Cocaine.” VASmeasures are collected prior to cocaine administration and at 5, 10, 15,20, 30, and 45 minutes following drug administration.

Fifteen minutes after cocaine administration participants are asked howmuch they would pay for that dose of drug, based on $50/gm (current costif purchases from illicit sources). This anchor is provided tostandardize responses given that the price of cocaine varies over timeand place.

On Day 13, the last day of treatment with study medication, all patientsparticipate in the “Experimental Sessions” where subjects make a seriesof choices between money and a double blinded infusion of placebo(saline) or 20 mg cocaine. In one of the sessions, only placebo (saline)is available. In the other session, only 20 mg cocaine is available.Participants choose to either self-administer placebo or accept moneyand 20 mg cocaine vs. money. This occurs in the morning (am) and in theafternoon (pm), with the order randomized and counterbalanced so thatplacebo or nepicastat is administered first to equal numbers ofsubjects.

Experimental (Choice) Session:

During each session subjects are asked to make a series of choicesbetween an infusion corresponding to a color (“blue” or “green”), andmoney. The color corresponds to the dose (cocaine 0 mg or 20 mg)administered to the subject during the sample session. For each of the 2choice sessions, participants make 10 choices for the infusion (cocaine0 mg IV in one session and cocaine 20 mg in the other) or money. Theparticipant makes a series of choices between ascending value moneyoptions ($0.05, $0.05, $0.05, $0.05, $1, $4, $7, $10, $13, and $16) orcocaine (0 mg or 20 mg/IV/infusion) using a patient-controlled analgesia(PCA) pump.

Infusion choices are performed by the participant using the PCA button,while choices for money are indicated verbally to the investigator.Infusions take place over 2-min followed by a 3-min time-out period. Assuch, selections are made at 5-min intervals.

Participants receive cocaine doses immediately after indicating theirchoice, providing vital signs remain within preset limits up to amaximum of 200 mg cocaine (10×20 mg). Money choices are given directlyto the patient immediately after the choice, but this money must bespent prior to discharge.

The table shows the Experimental choice sessions with 16 totalparticipants.

Choices 8 participants 8 participants am Choice 1 0 mg cocaine IV or$0.05 20 mg cocaine IV or $0.05 am Choice 2 0 mg cocaine IV or $0.05 20mg cocaine IV or $0.05 am Choice 3 0 mg cocaine IV or $0.05 20 mgcocaine IV or $0.05 am Choice 4 0 mg cocaine IV or $0.05 20 mg cocaineIV or $0.05 am Choice 5 0 mg cocaine IV or $1.00 20 mg cocaine IV or$1.00 am Choice 6 0 mg cocaine IV or $4.00 20 mg cocaine IV or $4.00 amChoice 7 0 mg cocaine IV or $7.00 20 mg cocaine IV or $7.00 am Choice 80 mg cocaine IV or $10.00 20 mg cocaine IV or $10.00 am Choice 9 0 mgcocaine IV or $13.00 20 mg cocaine IV or $13.00 am Choice 10 0 mgcocaine IV or $16.00 20 mg cocaine IV or $16.00 pm Choice 1 20 mgcocaine IV or $0.05 0 mg cocaine IV or $0.05 pm Choice 2 20 mg cocaineIV or $0.05 0 mg cocaine IV or $0.05 pm Choice 3 20 mg cocaine IV or$0.05 0 mg cocaine IV or $0.05 pm Choice 4 20 mg cocaine IV or $0.05 0mg cocaine IV or $0.05 pm Choice 5 20 mg cocaine IV or $1.00 0 mgcocaine IV or $1.00 pm Choice 6 20 mg cocaine IV or $4.00 0 mg cocaineIV or $4.00 pm Choice 7 20 mg cocaine IV or $7.00 0 mg cocaine IV or$7.00 pm Choice 8 20 mg cocaine IV or $10.00 0 mg cocaine IV or $10.00pm Choice 9 20 mg cocaine IV or $13.00 0 mg cocaine IV or $13.00 pmChoice 10 20 mg cocaine IV or $16.00 0 mg cocaine IV or $16.00

A sample size of 12 in the nepicastat-treated group allows detection ofmedium to large effects, which is appropriate for an initial assessment.The plot (FIG. 1) shows the effect size achieved with sample sizesranging from 5 to 15. Increasing the sample size above 12 would enhanceanalytical power to detect differences between the treatments but atincreasing cost. The placebo-treated group is included only to maintainthe blind and is not intended to serve as a comparison group.

The analysis focuses primarily on the effects of nepicastat in thenepicastat-treated group. The placebo-treated group is includedprimarily to maintain the blind. Side effects and adverse events (AEs)are tabulated and compared across treatment conditions using ANOVA orChi-square. Subjective and cardiovascular effects produced by IV cocaineand placebo during treatment with nepicastat are compared to thoseproduced during treatment with placebo using repeated measures (timebeing the repeated measure) analysis of variance (ANOVA), peak effectone-way ANOVA, and if indicated, area under the curve ANOVA.

Example 5

Bovine and human dopamine β-hydroxylase activity were assayed bymeasuring the conversion of tyramine to octopamine. Bovine adrenaldopamine β-hydroxylase was obtained from Sigma Chemicals (St Louis, Mo.,USA) whereas human dopamine p-hydroxylase was purified from the culturemedium of the neuroblastoma cell line SK-N-SH. The assay was performedat pH 5.2 and 32° C. in a medium containing 0.125 M NaAc, 10 mMfumarate, 0.5-2 μM CuSO₄, 0.1 mg·ml⁻¹ catalase, 0.1 mM tyramine and 4 mMascorbate. In a typical assay, 0.5-1 milliunits of enzyme were added tothe reaction mixture and, subsequently, a substrate mixture containingcatalase, tyramine and ascorbate was added to initiate the reaction(final volume of 200 μl). Samples were incubated with or without theappropriate concentration of nepicastat or Compound B at 37° C. for 30to 40 minutes. The reaction was quenched by the stop solution containing25 mM EDTA and 240 μM 3-hydroxytyramine (internal standard). The sampleswere analyzed for octopamine by reverse phase high pressure liquidchromatography (HPLC) using ultraviolet-detection at 280 nM. The IPLCchromatography run was carried out at the flow rate of 1 ml·min⁻¹ usinga LiChroCART 125-4 RP-18 column and isocratic elution with 10 mM acidicacid, 10 mM 1-heptane sulfonic acid, 12 mM tetrabutyl ammonium phosphateand 10% methanol. The remaining percent activity was calculated based oncontrols, corrected using internal standards and fitted to a non-linearfour-parameter concentration-response curve.

Nepicastat (S-enantiomer) and Compound B (R-enantiomer) producedconcentration-dependent inhibition of bovine and human dopamineβ-hydroxylase activity. The calculated ICS's for nepicastat were 8.5±0.8nM and 9.0±0.8 nM for the bovine and human enzyme, respectively.Compound B was slightly less potent (ICS's of 25.1±0.6 nM and 18.3±0.6nM for the bovine and human enzyme, respectively) than nepicastat.Nepicastat was shown to be a potent inhibitor of human and bovinedopamine β-hydroxylase in vitro. The inhibitory effects of the compoundwere stereospecific since the S-enantiomer (nepicastat) was marginally,but significantly, more potent than the R-enantiomer (Compound B).

The activity of nepicastat at twelve selected enzymes and receptors wasdetermined using established assays. A brief account of the principleunderlying each of the enzymatic assays is given in FIG. 2. Binding datawere analyzed by iterative curve-fitting to a four parameter logisticequation. Ki values were calculated from IC₅₀ values using theCheng-Prusoff equation. Enzyme inhibitory activity was expressed as IC₅₀(concentration required to produce 50% inhibition of enzyme activity).

Nepicastat had negligible affinity (IC₅₀s or Kis>10 μM) for a range ofother enzymes (tyrosine hydroxylase, acetyl CoA synthetase, acylCoA-cholesterol acyl transferase, Ca²⁺/calmodulin protein kinase II,cyclooxygenase-I, HMG-CoA reductase, neutral endopeptidase, nitric oxidesynthase, phosphodiesterase III, phospholipase A₂, and protein kinase C)and neurotransmitter receptors (α_(1A), α_(1B), α_(2A), α_(2B), β₁ andβ₂ adrenoceptors, M₁ muscarinic receptors, D₁ and D₂ dopamine receptors,μ opioid receptors, 5-HT_(1A), 5-HT_(2A), and 5-HT_(2C) serotoninreceptors). Nepicastat displayed a high degree of selectivity fordopamine p-hydroxylase as the compound possessed negligible affinity fortwelve other enzymes and thirteen neurotransmitter receptors.

In studies involving SHRs, the drugs, nepicastat((S)-5-aminomethyl-1-(5,7-difluoro-1,2,3,4-tetrahydronaphth-2-yl)-1,3-dihydroimidazole-2-thionehydrochloride) and the corresponding R-enantiomer (Compound B), weredissolved in distilled water and dosed orally with a gavage needle. Inthe dog studies, the drugs were filled in capsules and dosed orally. Alldoses are expressed as free base equivalents.

Male SHRs (15-16 weeks old, Charles River, Wilmington, Mass., USA) wereused in in vivo studies. On the day of the study, animals were weighedand randomly assigned to be dosed with either vehicle (control) or theappropriate dose of nepicastat (3, 10, 30 or 100 mg·kg⁻¹, po) orCompound B (30 mg·kg⁻¹, po) three consecutive times, twelve hours apart.At six hours after the third dose, the rats were anaesthetized withhalothane, decapitated and tissues (cerebral cortex, mesenteric arteryand left ventricle) were rapidly harvested, weighed, placed in icedperchloric acid (0.4 M), frozen in liquid nitrogen and stored at −70° C.until subsequent analysis. To quantify noradrenaline and dopamineconcentrations, tissues were homogenized by brief sonication andcentrifuged at 13,000 rpm for 30 minutes at 4° C. The supernatant,spiked with 3, 4-dihydroxybenzylamine (internal standard), was assayedfor noradrenaline and dopamine by IPLC using electrochemical detection.

Basal tissue catecholamine content (μg·g⁻¹ wet weight) in controlanimals were as follows: mesenteric artery (noradrenaline, 10.40±1.03;dopamine, 0.25±0.02), left ventricle (noradrenaline, 1.30±0.06;dopamine, 0.02±0.00) and cerebral cortex (noradrenaline, 0.76±0.03;dopamine, 0.14±0.01). Nepicastat produced dose-dependent reduction innoradrenaline content and enhancement of dopamine content anddopamine/noradrenaline ratio in the three tissues which were studied.

These changes attained statistical significance (p<0.05) at doses of >3mg·kg⁻¹ in the mesenteric artery and left ventricle but only at doses of30 and 100 mg·kg⁻¹ in the cerebral cortex. At the highest dose studied(100 mg·kg⁻¹, po), the decreases in noradrenaline were 47%, 35%, 42% andincreases in dopamine were 820%, 800% and 86% in the mesenteric artery,left ventricle and cerebral cortex, respectively. When tested at 30mg·kg¹, po, nepicastat produced significantly greater changes incatecholamine content, as compared to the R-enantiomer (Compound B), inthe mesenteric artery and left ventricle.

Male beagle dogs (10-16 kg, Marshall Farms USA Inc, North Rose, N.Y.,USA) were also used in in vivo studies. On the day of the study, dogswere weighed and randomly assigned to be orally dosed with either emptycapsules (control) or the appropriate dose of nepicastat (0.05, 0.5, 1.5or 5 mg·kg⁻¹; po, b.i.d.) for 5 days. At six hours following the firstdose on day-5, the dogs were euthanized with pentobarbital and thetissues (cerebral cortex, renal artery, left ventricle) were rapidlyharvested. The tissues were subsequently processed and analyzed fornoradrenaline and dopamine.

Data are expressed as mean standard error of the mean (SEM). Tissue andplasma catecholamine data were analyzed using a non-parametric one-wayanalysis of variance (ANOVA) or two-way ANOVA, respectively, followed bypairwise comparison using Fisher LSD test. P<0.05 was consideredstatistically significant.

Basal tissue catecholamine content (μg·g⁻¹ wet weight) in controlanimals were as follows: renal artery (noradrenaline, 10.7±1.05;dopamine, 0.22±0.01), left ventricle (noradrenaline, 2.11±0.18;dopamine, 0.07±0.03) and cerebral cortex (noradrenaline, 0.26±0.02;dopamine, 0.03±0.00). When compared to control animals, nepicastatproduced a dose-dependent reduction in noradrenaline content andenhancement of dopamine content and dopamine/noradrenaline ratio in thethree tissues which were studied.

These changes attained statistical significance (p<0.05) at dosesof >0.1 mg·kg¹·day⁻¹ in the three tissues. At the highest dose studied(5 mg·kg⁻¹, b.i.d., po), the decreases in noradrenaline were 88%, 91%and 96% and increases in dopamine were 627%, 700% and 166% in the renalartery, left ventricle and cerebral cortex, respectively.

Male beagle dogs were randomized to be orally dosed with either emptycapsules (control) or nepicastat (2 mg·kg⁻¹, po, b.i.d.) for 15 days.Daily venous blood samples were drawn, six hours after the first dose,for measurement of plasma concentrations of dopamine and noradrenaline.The samples were collected in tubes containing heparin and glutathione,centrifuged at −4° C. and the separated plasma was stored at −70° C.until analysis. The baseline concentrations of catecholamines in twogroups of animals were not significantly different from each other:plasma noradrenaline and dopamine concentrations were 460.3±59.6 and34.4±11.9 pg·ml⁻¹, respectively, in the control group and 401.9±25.5 and41.1±8.8 pg·ml⁻¹, respectively, in the nepicastat-treated group. Whencompared to the control group, nepicastat (2 mg·kg⁻¹, b.i.d, po)produced significant decreases in plasma concentrations of noradrenalineand increases in plasma concentrations of dopamine anddopamine/noradrenaline ratio.

Inhibitory modulation of sympathetic nerve function, throughpharmacological means, is an attractive therapeutic strategy for themanagement of congestive heart failure, inasmuch as elevated activity ofthis system has been implicated in the progressive worsening of thedisease. The aim of this study was to pharmacologically characterize theeffects of nepicastat, a compound which modulates noradrenalinesynthesis in sympathetic nerves by inhibiting the enzyme dopamineβ-hydroxylase.

Inhibition of dopamine β-hydroxylase in vivo would be expected to resultin elevated levels of the substrate (dopamine) and diminished levels ofthe product (noradrenaline) in tissues which receive noradrenergicinnervation. This expectation was borne out in experiments whichinvestigated the effects of nepicastat on catecholamine levels incentral and peripheral tissues in vivo. In both SHRs and beagle dogs,nepicastat produced dose-dependent reductions in noradrenaline contentand increases in dopamine content in peripheral (mesenteric or renalartery, left ventricle) and central (cerebral cortex) tissues. In thisrespect, Compound B was less potent than nepicastat which is consistentwith the lower IC₅₀ of the former enantiomer for the enzyme. Althoughdopamine/noradrenaline ratio was also elevated, there did not appear tobe stoichiometric replacement of noradrenaline with dopamine. The mostlikely explanation for this finding is that tissue levels of dopaminemay have been underestimated due to intraneuronal metabolism ofdopamine.

The ability of nepicastat to alter catecholamine levels in the cerebralcortex suggests that the drug does penetrate the blood brain barrier. Indogs, the magnitude of the changes in catecholamines in the cerebralcortex appeared comparable to those in peripheral tissues. In SHRs,however, nepicastat, at low doses (≤10 mg·kg), produced significantchanges in noradrenaline and dopamine content in peripheral tissueswithout affecting catecholamines in the cerebral cortex. This suggeststhat, at least in SHRs, the drug does possess modest peripheralselectivity.

Plasma noradrenaline concentrations provide a useful measure of overallsympathetic nerve activity although this parameter may be influenced byalterations in neuronal uptake and metabolic clearance of thecatecholamine. Baseline concentrations of noradrenaline in the plasmawere surprisingly elevated in the dogs and is, perhaps, a reflection ofthe initial stress induced by the phlebotomy blood-sampling procedure.Nevertheless, compared to the control group, nepicastat producedsignificant decreases in plasma noradrenaline concentrations consistentwith reduced transmitter synthesis and release although an indirecteffect, secondary to facilitation of neuronal uptake or metabolicclearance, cannot be discounted. Since released noradrenaline representsa small fraction of the total neuronal noradrenaline stores, aninhibitor of noradrenaline biosynthesis would affect noradrenalinerelease only after existing stores of the catecholamine have beensufficiently depleted. Accordingly, the decreases in plasmanoradrenaline concentrations did not attain statistical significanceuntil 4 days of dosing with nepicastat suggesting gradual modulation ofthe sympathetic nervous system.

A growing body of evidence suggests that chronic activation of thesympathetic nervous system in congestive heart failure is a maladaptiveresponse. This contention is supported by clinical trials which haveshown a beneficial effect of carvedilol in congestive heart failurepatients with respect to long-term morbidity and mortality. However, itshould be noted that most patients do require some level of sympatheticdrive to support cardiovascular homeostasis. Indeed, the therapeuticvalue of P-blockers, including carvedilol, may be limited by theirpropensity to cause hemodynamic deterioration especially duringinitiation of therapy. This unwanted effect, which results from abruptwithdrawal of sympathetic support, necessitates careful dose-titration.Inhibitors of dopamine β-hydroxylase, such as nepicastat, may be devoidof this undesirable effect for the following reasons. First, this classof drugs would attenuate, but not abolish, noradrenaline release and,second, they produce gradual modulation of the system thereby obviatingthe need for dose-titration. Another advantage of nepicastat overP-blockers is that it enhances dopamine levels which, via agonism ofdopamine receptors, may have salutary effects on renal function such asrenal vasodilation, diuresis and natriuresis.

Nepicastat is a potent, selective and orally active inhibitor ofdopamine β-hydroxylase which may be of value in the treatment ofcardiovascular disorders associated with over-activation of thesympathetic nervous system.

Example 6

The preparation of nepicastat was based upon the chiral reduction oftetralone 3 (available from the AlCl₃-catalyzed Friedel-Crafts reactionof 3,5-difluorophenylacetyl chloride with ethylene in CH₂Cl₂ at −65° C.)under the conditions described by Terashima (LAH,(−)-1R,2S—N-methylephedrine, 2-ethylaminopyridine) to giveR-(+)-tetralol 4a (92-95% ee), that was converted to the R-(+)-mesylate,followed by reaction with sodium azide afforded a mixture (9:1) of azideand dihydronaphthalene 7. The azide was hydrogenated and the producttreated with anhydrous HCl to give S-(−)-amine hydrochloride, convertedby a Strecker reaction (formaldehyde bisulfite complex and KCN) toS-(−)-aminonitrile. Formation of the heterocycle was accomplished bysequential diformylation of aminonitrile followed by subsequenttreatment with thiocyanic acid. Competing hydrolysis of the nitrileafforded comparable amounts of the primary amide. Reduction of nitrileto amine (93-96% ee) was accomplished using LAH in THF. The enantiomer(91.6% ee) was available by the same above described route using(+)-1S,2R—N-methylephedrine as a chiral auxiliary in the Terashimareduction of ketone. The absolute configuration of the chiral center wasbased upon literature precedence of the previously describedS-(−)-2-tetralol.

Melting points were determined on a Uni-Melt Thomas Hoover CapillaryMelting Point Apparatus or a Mettler FB 81HT cell with a Mettler FP90processor and are uncorrected. Mass spectra were obtained with either aFinnigan MAT 8230 (for electron-impact or chemical ionization) orFinnigan MAT TSQ70 (for LSIMS) spectrometer. ¹H NMR spectra wererecorded on a Bruker ACF300, AM300, AMX300 or EM390 spectrometer andchemical shifts are given in ppm (δ) from tetramethylsilane as internalstandard. IR spectra were recorded on a Nicolet SPC FT-IR spectrometer.UV spectra were recorded on a Varian Cary 3 UV-Visible spectrometer,Leeman Labs Inc. Optical rotations were measured in a Perkin-Elmer Model141 polarimeter. Chiral HPLC measurements were performed on a RegisChiral AGP column (4.6×100 mm) eluting with 2% acetonitrile-98% 20 mMKH₂PO₄ (pH 4.7) at 1 mL/min at 20° C.

5,7-Difluoro-2-tetralone. SOCl₂ (100 mL) was added in one portion to3,5-difluorophenylacetic acid (100 g, 0.58 mol) and after stirring for15 h, the volatiles were evaporated under reduced pressure. Theresulting oily acid chloride was dissolved in CH₂Cl₂ (200 mL) and addeddropwise to a mechanically stirred suspension of AlCl₃ (154 g, 1.16 mol)in CH₂Cl₂ (1.0 L). The stirred suspension was cooled to an internaltemperature of −65° C. in a dry ice/acetone bath, and the acid chloridesolution was added at such a rate in order to maintain an internaltemperature <−60° C. After the addition was complete, ethylene gas wasbubbled through the reaction mixture at a rapid rate for 10 min at −65°C. The reaction mixture was allowed to warm to 0° C. over 2 h withstirring, and was then cooled to −10° C. and treated with H₂O (500 mL)initially dropwise, followed by rapid addition. The organic layer wasseparated, washed with brine (100 mL) and dried over MgSO₄. Evaporationunder reduced pressure gave a dark oily residue which was distilled invacuo on a Kugelrohr collecting material boiling between 90-110° C. (1.0to 0.7 mm Hg). The distillate was redistilled at 100-105° C. (0.3 mm Hg)to give the product as a white solid, (73.6 g, 0.40 mol; 70%): mp 46°C.; IR (KBr) 1705 cm¹; ¹H NMR (CDCl₃) δ 2.55 (t, J=7.5 Hz, 2H), 3.10 (t,J=7.5 Hz, 2H), 3.58 (s, 2H), 6.70 (m, 2H); MS m/z 182 (M⁺). Anal. Calcdfor C₁₀H₈F₂O: C, 65.93; H, 4.42. Found: C, 65.54; H, 4.42.

(R)-(+)-2-Hydroxy-5,7-difluoro-1,2,3,4-tetrahydronaphthalene. A solutionof (−)-1R,2S—N-methylephedrine (81.3 g, 0.454 mol) in anhydrous Et₂O(1.1 L) was added dropwise (45 min) to 1.0 M lithium aluminum hydride(416 mL, 0.416 mol) in Et₂O at a rate sufficient to maintain a gentlereflux. After the addition was complete, the reaction mixture was heatedat reflux for 1 h then allowed to cool to room temperature. A solutionof 2-ethylaminopyridine (111 g, 0.98 mole) in anhydrous Et₂O (100 mL)was added (45 min) at such a rate as to maintain a gentle reflux. Thereaction mixture was heated at reflux for a further 1 h, during whichtime a light yellow-green suspension appeared. The mixture was cooled toan internal temperature of −65° C. using a dry ice-acetone bath and asolution of 5,7-difluoro-2-tetralone (23.0 g, 126 mmol) in Et₂O (125 mL)was added dropwise at a rate maintaining the internal temperature below−60° C. After the addition was complete, the mixture was stirred at −65°C. to −68° C. for 3 h and quenched by the addition of MeOH (100 mL)maintaining the internal temperature below −60° C. The reaction wasstirred for a further 10 min at −65° C. and allowed to warm toapproximately −20° C. A solution of 3N HCl (2 L) was then added at arate to limit the temperature to <35° C. After stirring at an increasedrate to achieve total dissolution, the layers were separated and theethereal layer was washed with brine (200 mL) and dried (MgSO₄). Theethereal solution was evaporated under reduced pressure and the residuedissolved in warm Et₂O (20 mL) followed by the addition of hexane (200mL). The seeded solution was cooled in an ice bath and maintained at 0°C. for 1 h whereupon the resulting deposited crystals were collected anddried in vacuo to give the alcohol (10.9 g, 47%): mp 85° C.; [α]²⁵_(D)+38.1° (c=1.83, CHCl₃); 93.4% ee by chiral HPLC: ¹H NMR (CDCl₃) δ1.70 (br s, 1H), 1.76-1.88 (m, 2H), 1.99-2.06 (m, 2H), 2.63-3.08 (m,3H), 4.15 (m, 1H), 6.60 (m, 2H). Anal. Calcd for C₁₀H₁₀F₂O: C, 65.21; H,5.47. Found: C, 65.38: H, 5.42. The spectra for the (S)-enantiomer 4bare identical: mp 84-85° C.; [α]²⁵ _(D)−37.8° (c=1.24, CHCl₃); 92.4% eeby chiral HPLC. Anal. Calcd for C₁₀H₁₀F₂O: C, 65.21; H, 5.47. Found: C,65.47; H, 5.39.

(R)-(+)-2-Methanesulfonyloxy-5,7-difluoro-1,2,3,4-tetrahydronaphthalene.A solution of R-(+)-5,7-difluoro-2-tetralol (59.0 g, 320 mmol) and Et₃N(74.2 mL, 53.9 g, 530 mmol) in anhydrous Et₂O (1.78 L) was cooled (−15°C.) using an ice-MeOH bath and treated under argon with stirring withMsCl (37.2 mL, 55.3 g, 480 mmol) over 5-10 min. After 5 h the reactionwas complete (as determined by TLC) and water was added to dissolve thesolids. A small amount of EtOAc was added to help complete dissolutionof the solids. The organic phase was separated and washed sequentiallywith 1N HCl, aq. NaHCO₃, brine and dried over MgSO₄. Evaporation of thesolvent gave an off-white solid (87.1 g, 332 mmol), used directly in thenext step. Trituration of a small sample with i-Pr₂O gave an analyticalsample: mp 78.8-80.5° C.; [α]²⁵ _(D)+16.8° (c=1.86, CHCl₃); ¹H NMR δ2.13-2.28 (m, 2H), 2.78-2.96 (m, 2H), 3.07 (s, 3H), 3.09 (dd, J=17.1 Hz,4.7, 1H), 3.20 (dd, J=17.2, 4.7 Hz, 1H), 5.20 (m, 1H), 6.67 (m, 2H).Anal. Calcd for C₁₁H₁₂F₂O₃S: C, 50.37; H, 4.61. Found: C, 50.41; H,4.64. The spectra for the (S)-enantiomer 5b are identical: mp 79.9-80.9°C.; [α]²⁵ _(D)−16.6° (c=2.23, CHCl₃). Anal. Calcd for C₁₁H₁₂F₂O₃S: C,50.37; H, 4.61. Found: C, 50.41; H, 4.65.

(S)-(−)-2-Amino-5,7-difluoro-1,2,3,4-tetrahydronaphthalenehydrochloride. Sodium azide (40.0 g, 0.62 mol) was added to DMSO (1 L)with stirring until a clear solution was obtained. The mesylate (138 g,0.53 mol) was added in one portion and the mixture heated at 50° C. for16 h under a N₂ atmosphere. The reaction mixture was diluted with H₂O(1.8 L) and extracted with pentane (4×250 mL) followed by sequentiallywashing the combined pentane extracts with H₂O (2×100 mL), brine (100mL) and drying over MgSO₄. Evaporation of the solvent under reducedpressure gave a volatile oil which was rapidly chromatographed on silicaing pentane as the eluent to give dihydronaphthalene (8.50 g, 51.2 mmol)as a volatile oil. Further elution with pentane/CH₂Cl₂ (9:1) affordedthe azide (101 g, 483 mmol) as a colorless oil: IR (CHCl₃) 2103 cm⁻¹;m/z 171 (M⁺). The azide 6a was dissolved in EtOAc (1200 mL) andhydrogenated over 10% Pd/C (6 g) in a 2.5 L Parr bottle (60 psi) for 6h. After each hour, the bottle was evacuated and recharged with hydrogento remove evolved N₂. The resulting mixture was filtered through Celite,stirred with ethereal HCl (1N, 500 mL), and the fine precipitatefiltered off and washed with EtOAc, and then anhydrous ether. (Thefiltration took about 4 h). The moist solid was transferred to around-bottom flask, and the remaining solvent removed in vacuo to give awhite solid (90.4 g, 412 mmol; 77.9%): mp>280° C.; [α]²⁵ _(D)−60.2°(c=2.68, MeOH); ¹H NMR (d₆-DMSO) δ 1.79 (m, 1H), 2.33 (m, 1H), 2.63 (m,1H), 2.83-2.92 (m. 2H), 3.14 (dd, J=16.7, 5.0 Hz, 1H), 3.46 (m, 1H),6.93 (d, J=9.4 Hz, 1H), 7.00 (dt, J=9.4, 2.5 Hz, 1H). Anal. Calcd forC₁₀H₁₂ClF₂N: C, 54.68; H, 5.51; N, 6.37. Found: C, 54.31; H, 5.52; N,6.44. The spectra for the (R)-enantiomer 8b are identical: mp>280° C.;[α]²⁵ _(D)+58.5⁰ (c=1.63, MeOH). Anal. Calcd for C₁₀H₁₂ClF₂N: C, 54.68;H, 5.51; N, 6.37. Found: C, 54.64; H, 5.51; N, 6.40.

(S)-(−)-(5,7-Difluoro-1,2,3,4-tetrahydronaphth-2-yl)(cyanomethyl)amine.The amine hydrochloride 8a (50.27 g, 229 mmol) was treated with asolution of NaOH (10.0 g. 250 mmol) in water (150 mL), followed by a fewadditional pellets of NaOH sufficient to obtain a solution. Furtherwater (300 mL) was added and the mixture placed in a 50° C. bath andtreated with formaldehyde sodium bisulfite complex (30.8 g, 230 mmol).After the mixture had been stirred for 30 min, KCN (15.0 g, 230 mmol)was added. The reaction mixture was stirred for a further 1 h at 80° C.,cooled to room temperature, and extracted with EtOAc to give an oil(51.3 g) which solidified. TLC (5% MeOH—CH₂Cl₂) showed ca. 10-15% ofstarting amine remained. Chromatography on silica gave the nitrileproduct (39.4 g) and starting free amine (7.12 g), which quickly formsthe carbonate in air. Recycling this amine gave an additional 5.35 g ofproduct. Combined yield (44.8 g, 202 mmol; 87.5%): mp 73.1-76.5° C.;[α]²⁵ _(D)−58.0° (c=1.63, CHCl₃); ¹H NMR (CDCl₃) δ 1.50 (br s, 1H), 1.70(m, 1H), 2.05 (m, 1H), 2.55-3.04 (m, 4H), 3.22 (m, 1H), 3.70 (s, 2H),6.62 (m, 2H); MS m/z 222 (M⁺). Anal. Calcd for C₁₂H₁₂F₂N₂: C, 64.85; H,5.44; N, 12.60. Found: C, 65.07; H, 5.47; N, 12.44. The spectra for the(R)-enantiomer 9b are identical: mp 64.4-73.6° C.; [α]²⁵ _(D)+52.3°(c=2.12, CHCl₃). Anal. Calcd for C₁₂H₁₂F₂N₂: C, 64.85; H, 5.44; N,12.60. Found: C, 65.14; H, 5.54; N, 12.53.

(S)-(−)-1-(5,7-Difluoro-1,2,3,4-tetrahydronaphth-2-yl)-5-cyano-2,3-dihydro-2-thioxo-1H-imidazole.The nitrile (44.7 g, 201 mmol) in butyl formate (240 mL) was heated atreflux (120° C. bath) under N₂ for 19 h, and the solvent then removedunder reduced pressure. Toluene was added and evaporated to remove lasttraces of solvent, and the residue was dried under high vacuum to givean oil (53.2 g). The resulting formamide and ethyl formate (48.7 mL,44.7 g, 604 mmol) in anhydrous THE (935 mL) were cooled in ice/MeOH(−15° C.) and stirred while t-BuOK (1M in THF, 302 mL, 302 mmol) wasadded over 20 min. After the reaction had been stirred for 18 h, thesolvent was evaporated, the residue dissolved in 1N HCl (990 mL) andethanol (497 mL), and treated with KSCN (78.1 g, 804 mmol). The mixturewas stirred for 135 min at 85° C. and then placed in an ice bath to givea precipitate. The filtered solid was loaded as a slurry in 10%MeOH/CH₂Cl₂ on to a silica (1 kg) column packed in hexane. Elution with10% acetone/CH₂Cl₂ gave the product (18.05 g, 62.1 mmol; 30.8%): m.p.240.7-249.2° C.; [V]²⁵ _(D)−69.1° (c=1.18, DMSO); ¹H NMR (d₆-DMSO) δ2.18 (br m, 1H), 2.47 (m, 1H), 2.75 (m, 1H), 3.03-3.35 (m, 3H), 5.19 (m,1H), 6.94 (d, J=9.3 Hz, 1H), 7.03 (dt, J=9.3, 2.4 Hz, 1H), 8.29 (s, 1H),13.3 (br s, 1H); MS m/z 291 (M⁺). Anal. Calcd for C₁₄H₁₁F₂N₃S: C, 57.72;H, 3.80; N, 14.42. Found: C, 57.82; H, 3.92; N, 14.37. (Further elutionof the column with 1:1 MeOH/CH₂Cl₂ gave the primary amide 11a: mp261.9-262.7° C.; [V]²⁵ _(D)−90.5⁰ (c=0.398); IR (KBr) 1593, 1630 cm⁻¹;¹H NMR (d₆-DMSO) δ 2.14 (m, 1H), 2.15-2.28 (m, 1H), 2.74-3.05 (m, 4H),5.64 (m, 1H), 6.90 (d, J=9.2 Hz, 1H), 7.05 (dt. J=9.5, 2.4 Hz, 1H), 8.73(s, 1H), 9.70 (br s, 1H), 13.7 (br s, 1H); MS m/z 309 (M). Anal. Calcdfor C₁₄H₁₃F₂N₃OS.0.25H₂O: C, 53.57; H, 4.33; N, 13.39. Found: C, 53.32;H, 3.96: N, 13.24. The spectra for the (R)-enantiomer are identical: mp243.1-244.7° C.; [V]²⁵ _(D)+74.9° (c=2.14, DMSO). Anal. Calcd forC₁₄H₁₁F₂N₃S: C, 57.72; H, 3.80; N, 14.42. Found: C, 57.85; H, 3.85; N,14.45.

(S)-1-(5,7-Difluoro-1,2,3,4-tetrahydronaphth-2-yl)-5-aminomethyl-2,3-dihydro-2-thioxo-1H-imidazole.The above nitrile (5.00 g, 17.2 mmol) in THF (75 mL) was stirred underargon in an ice bath until a homogeneous solution was obtained. Asolution of LAH in THF (1 M, 34.3 mL, 34.3 mmol) was added dropwise over10 min, then the solution was stirred for 30 min at 0° C. and allowed tocome to room temperature for 1.5 h. The reaction was again cooled to 0°C. and treated with a saturated solution of sodium potassium tartrateuntil the mixture became freely stirrable. Further tartrate solution (30mL) was added, followed by 10% MeOH/CH₂Cl₂ (200 mL) and the mixturestirred for 15 min and treated with water (100-150 mL). The organiclayer was separated and the aqueous phase extracted with 10% MeOH/CH₂Cl₂(2×125 mL). The combined extracts were washed, dried (MgSO₄), andevaporated. Chromatography of the residue (5.2 g) on silica eluting with5% MeOH/CH₂Cl₂ gave the free amine (2.92 g, 9.89 mmol; 58%): mp 170° C.;[∀]²⁵ _(D)−11.0° (c=1.59, DMSO). Anal. Calcd for C₁₄H₁₅F₂N₃S.0.25H₂O: C,56.07; H, 5.21; N, 14.01. Found: C, 56.11; H, 5.10; N, 14.14.

(S)-1-(5,7-Difluoro-1,2,3,4-tetrahydronaphth-2-yl)-5-aminomethyl-2,3-dihydro-2-thioxo-1H-imidazolehydrochloride (nepicastat). The hydrochloride salt was prepared by theaddition of ethereal HCl (1M, 20 mL, 20 mmol) to the free amine 2a (3.12g, 10.6 mmol) which had been dissolved in MeOH (250 mL) by warming. Thesolvent was partially removed under reduced pressure and displaced byco-evaporation with EtOAc several times without evaporating to dryness.The resulting precipitate was treated with EtOAc (150 mL) and ether (150mL), filtered off, washed with ether, and dried under nitrogen and thenunder high vacuum at 78° C. for 20 h to give the hydrochloride salt(3.87 g): mp 245° C. (dec); [α]²⁵ _(D)+9.65° (c=1.70, DMSO); (93% ee bychiral HPLC); ¹H NMR (T=320° K, DMSO) δ 2.07 (m, 1H), 2.68-3.08 (m, 4H),4.09 (m, 3H), 4.77 (m, 1H), 6.84 (m, 2H), 7.05 (s, 1H), 8.57 (br s, 3H),12.4 (br s, 1H). Anal. Calcd for C₁₄H₁₆ClF₂N₃S.0.5H₂O: C, 49.33; H,5.03; N, 12.33. Found: C, 49.44; H, 4.96; N, 12.18. The spectra for the(R)-enantiomer(R)-1-(5,7-Difluoro-1,2,3,4-tetrahydronaphth-2-yl)-5-aminomethyl-2,3-dihydro-are identical; mp 261-263° C.; [α]²⁵ _(D)−10.8° (c=1.43, DMSO), 91.6% eeby chiral HPLC. Anal. Calcd for C₁₄H₁₆ClF₂N₃S.0.35H₂O: C, 49.73; H,4.98; N, 12.42. Found: C, 49.80; H, 4.93; N, 12.39.

Nepicastat was demonstrated to be a competitive inhibitor of bovine(IC₅₀=8.5 0.8 nM) and human (IC₅₀=9.0 0.8 nM) DBH. The R-enantiomer(R)-1-(5,7-Difluoro-1,2,3,4-tetrahydronaphth-2-yl)-5-aminomethyl-2,3-dihydro-(IC₅₀s=25.1±0.6nM; 18.3±0.6 nM) and SKF 102698 (IC₅₀s=67.0±4.2 nM; 85.0±3.7 nM) areless potent inhibitors of the bovine and human enzymes, respectively.DBH activity was assayed by measuring the conversion of tyramine tooctopamine. Bovine DBH from adrenal glands was obtained from SigmaChemical Co (St Louis, Mo.). Human secretory DBH was purified from theculture medium of the neuroblastoma cell line SK—N—SH. The assay wasperformed at pH 5.2 and 32° C. in 0.125 M NaOAc, 10 mM fumarate, 0.5-2μM CUSO₄, 0.1 mg/mL catalase, 0.1 mM tyramine and 4 mM ascorbate. In atypical assay, 0.5-1 milliunits of enzyme were added to the reactionmixture and then a substrate mixture containing catalase, tyramine andascorbate was added to initiate the reaction (final volume of 200 μL).Samples were incubated with or without the appropriate concentration ofthe inhibitor at 37° C. for 30-40 min. The reaction was quenched by thestop solution containing 25 mM EDTA and 240 μM 3-hydroxytyramine(internal standard). The samples were analyzed for octopamine by reversephase HPLC using UV detection at 280 nM. The remaining percent activitywas calculated based on controls (without inhibitor), corrected usinginternal standards and fitted to a non-linear 4-parameterconcentration-response curve to obtain IC₅₀ values.

The activity of nepicastat at eleven different enzymes was determinedusing established assays. The affinity of nepicastat for thirteenselected receptors was determined by radioligand binding assays usingstandard filtration techniques and membrane preparations. Binding datawere analyzed by iterative curve fitting to a four parameter logisticequation. K_(i) values were calculated using the Cheng-Prusoff equation.FIG. 3 shows a table describing the interaction of nepicastat at DBH anda range of selected enzymes and receptors. Nepicastat showed weakaffinity for a range of other enzymes and neurotransmitter receptors.These data suggest that nepicastat is a potent and highly selectiveinhibitor of DBH in vitro. Moreover, the S-enantiomer nepicastat isapproximately 2-3 fold more potent than the R-enantiomer suggestingstereoselectivity.

Oral administration of nepicastat to spontaneously hypertensive rats(SHRs) and normal dogs produced potent and dose-dependent increases intissue dopamine (DA)/norepinephrine (NE) ratios in peripheral arteries(renal or mesenteric), left ventricle and cerebral cortex. Chronic oraladministration of nepicastat to normal dogs also produced sustainedincreases in the plasma DA/NE ratio. In conscious SHRs, acute oraladministration of nepicastat produced dose-dependent and long-lasting(>4 h) antihypertensive effects and also attenuation of the pressorresponses to pre-ganglionic sympathetic nerve stimulation. Serum T₃ andT₄ levels were unaffected by a dose (6.2 mg/kg, po, b.i.d. for 10 days)which elevated the dopamine/norepinephrine ratio in the mesentericartery. On the basis of its ability to potently modulate the sympatheticdrive to cardiovascular tissues, nepicastat has been clinical evaluatedfor the treatment of congestive heart failure.

Congestive heart failure (CHF) is a leading cause of mortality in theUnited States. CHF is characterized by marked activation of thesympathetic nervous system (SNS) and renin-angiotensin system (RAS). Thesimultaneous activation of these two neurohormonal systems has beenincreasingly implicated in the perpetuation and progression of CIF.Therapeutic interventions which block the effects of these neurohormonalsystems are likely to favorably alter the natural history of CHF.Indeed, angiotensin-converting enzyme (ACE) inhibitors, which blockformation of angiotensin II, have been shown to reduce morbidity andmortality in CHF patients. ACE inhibitors, however, have a limitedindirect ability to attenuate the SNS. Inhibition of the SNS withβ-adrenoceptor antagonists is a promising approach that is currentlyunder clinical evaluation. An alternative strategy to directly modulatethe SNS is inhibition of norepinephrine (NE) biosynthesis via inhibitionof dopamine β-hydroxylase (DBH), the enzyme responsible for conversionof NE to dopamine (DA). Inhibition of DBH would be expected to reducetissue levels of NE and elevate tissue levels of DA thereby increasingthe tissue DA/NE ratio. This approach has potential advantages overp-adrenoceptor antagonists, such as reduced stimulation ofα-adrenoceptors and elevated DA levels that can produce renalvasodilation, natriuresis and diminished aldosterone release. PreviousDBH inhibitors, such as fusaric acid and SKF-102698, have drawbacks suchas low potency and specificity, that have precluded their clinicaldevelopment in heart failure.

Nepicastat was used in in vivo biochemical studies to study the effectsin spontaneously hypertensive rats (SHRs) and normal beagle dogs. On theday of the study, the animals were weighed and randomly assigned toreceive either placebo (vehicle) or the appropriate dose of nepicastat.Each rat was dosed orally three times, 12 h apart, beginning in themorning. At 6 h after the third dose, the rats were anesthetized withhalothane, decapitated, and the tissues (cerebral cortex, mesentericartery and left ventricle) were rapidly harvested, weighed, placed iniced 0.4 M perchloric acid, frozen in liquid nitrogen and stored at −70°C. until analysis. Tissue NE and DA concentrations were assayed by HPLCusing electrochemical detection. Male beagle dogs (10-16 kg, MarshallFarms USA Inc, North Rose, N.Y.) were used in the study. On the day ofthe study, dogs were randomly assigned to receive either placebo (emptycapsule) or the appropriate dose of nepicastat. Each dog was dosed twicea day for 4.5 days. 6 h after the first dose on day 5, the dogs wereeuthanized with pentobarbital and the tissues (cerebral cortex. renalartery, left ventricle) harvested, weighed, placed in iced 0.4 Mperchloric acid, frozen in liquid nitrogen and stored at −70° C. untilanalysis. Tissue NE and DA concentrations were assayed by HPLC usingelectrochemical detection.

Oral administration of nepicastat produced dose-dependent increases inDA/NE ratios in the artery (mesenteric or renal), left ventricle andcerebral cortex in SHRs and dogs.

At the highest dose tested (100 mg/kg in SHRs and 5 mg/kg in dogs) themaximal increases in DA/NE ratio were 14, 11 and 3.2 fold (in SHRs) and95, 151 and 80 fold (in dogs) in the artery, left ventricle and cerebralcortex, respectively. When tested at 30 mg/kg in SHRs, SKF-102698 (1)increased the DA/NE ratio by 5.5-fold, 3.5-fold and 2.7-fold, whereasnepicastat, at the same dose, increased the ratio by 8.3, 7.5 and 1.5fold in the mesenteric artery, left ventricle and cerebral cortex,respectively. Compound B at 30 mg/kg in SHRs, produced only 2.6, 3.5 and1.1 fold increases in the DA/NE ratio in the mesenteric artery, leftventricle and cerebral cortex, respectively. These data suggest thatnepicastat produces the expected biochemical effects in both SHRs anddogs but is more potent in the latter species. Furthermore, nepicastatis more potent than its Compound B and SKF-102698 (1) in SHRs.

The chronic effects of nepicastat (14.5 day treatment) on the plasmaDA/NE ratio were investigated in normal dogs. Animals were randomized toreceive, orally, either placebo (empty capsule) or nepicastat (2 mg/kg,b.i.d) for 14.5 days. Daily blood samples were drawn, 6 h after thefirst dose, for the measurement of plasma concentrations of DA and NE.The samples were collected in tubes containing heparin and glutathione,centrifuged at −4° C. and stored at −70° C. until analysis.

Oral administration of nepicastat (2 mg/kg; b.i.d) produced asignificant increase in the DA/NE ratio that attained its peak effect atapproximately 6-7 days, then plateaued to a new steady-state between7-14 days.

The in vivo hemodynamic activity of nepicastat was further assessed inconscious, restrained SHRs, a model having high sympathetic drive tocardiovascular tissues. Hemodynamic study in SHRs. Male SHRs (15-16 weekold) were used in the study. The animals were lightly anesthetized withether and the left femoral artery and vein were catheterized formeasurement of blood pressure and drug administration, respectively. Theanimals were placed in restrainers and allowed to recover for 30-40 min.After obtaining baseline measurements, the animals were treated, orally,with either vehicle or the appropriate dose of nepicastat andhemodynamic parameters were continuously recorded for 4 h. The animalswere then anesthetized with pentobarbital, placed on a heating pad (37°C.) and ventilated with a Harvard rodent ventilator. Afteradministration of atropine (1 mg/kg, iv) and tubocurarine (1 mg/kg, iv),the animals were pithed through the orbit of the eye with a stainlesssteel rod. The pithing rod was stimulated electrically with 1 ms pulsesof 80V at different frequencies (0.15, 0.45, 1.5, 5, 15 Hz) to obtainfrequency-pressor response curves.

Oral dosing of nepicastat resulted in a dose-dependent antihypertensiveeffect. The animals were placed in restrainers and allowed to recoverfor 30-40 minutes. After obtaining baseline measurements, the animalswere treated, orally, with either vehicle or the appropriate dose ofnepicastat and hemodynamic parameters were continuously recorded for 4h. Nepicastat produced significant (p<0.05) lowering of mean arterialpressure at all doses and time points, except at 0.3 mg/kg (180, 210 and240 min) and 1 mg/kg (30, 210 and 240 min).

A maximal decrease in mean blood pressure of 53±4 mmHg (33% reductionrelative to vehicle control) was observed at the 10 mg/kg dose. Theresponse was slow in onset, reaching its plateau in 3-4 h. The precisereason for the loss of anti-hypertensive efficacy at the highest dose(30 mg/kg) is unclear at present. Heart rate was not significantlyaffected except for a slight yet significant decrease at 10 and 30mg/kg, (9.8 and 10.5%, respectively). Following this study, the ratswere pithed and the effects of nepicastat on the pressor response topre-ganglionic nerve stimulation (PNS) of the spinal cord were evaluated5 h after dosing. The frequency-pressor response curve was shiftedsignificantly (p<0.05) to the right in a dose-dependent manner (maximumshift of ˜5 fold in the frequency-response curve). The heart rateresponse to PNS was not significantly affected. These data suggest thatnepicastat inhibits the sympathetic drive to the vasculature and is theprobable mechanism for its anti-hypertensive effect in SHRs.

Since the heterocyclic portion of nepicastat is structurally similar tomethimazole, a known potent suppressor of mammalian thyroid function,the effects of nepicastat on thyroid function were evaluated at doses of2.0 and 6.2 mg/kg, po, b.i.d in iodine-deficient Sprague-Dawley rats(n=9-12) for 10 days. Methimazole (1 mg/kg, po, b.i.d.), used as apositive control, caused a significant reduction in serum levels of T₃(day 3, 31%, p<0.05; days 7 and 9, 42% and 44%, p<0.01) and T₄ (days 3and 7, 46% and 58%, p<0.01) 4 h post-dose, whereas nepicastat showed nosignificant effects throughout the study (days 3, 7 and 9). Both dosesof nepicastat significantly raised the DA/NE ratio in the mesentericartery (p<0.01 relative to vehicle controls) but not in the cortex 4 hafter the final dose on day 10.

The findings of this study suggest that nepicastat is a potent,selective and orally active inhibitor of DBH. The compound is alsodevoid of significant behavioral effects in animal models and thesefindings will be the subject of a future publication. As compoundnepicastat effectively modulates the sympathetic drive to cardiovasculartissues, it has been tested for the treatment of CHF.

Example 7

Concentrations of dopamine and norepinephrine were determined in 942samples of plasma collected from congestive heart failure (CHF)patients. The objectives of the study were:

1. to evaluate the effects of various doses of nepicastat ontransmyocardial (arterial-coronary sinus) and coronary sinuscatecholamine levels after four weeks, and to evaluate the safety andtolerability of nepicastat over 12 weeks.

2. to evaluate the effects of nepicastat on changes from baseline in:

a) Plasma (venous) catecholamine levels after four weeks and 12 weeks

b) Quality of life (QoL), CHF symptoms, Global Assessments, and NYHAclass after four weeks and 12 weeks

c) Hemodynamic parameters, including cardiac output, systemic vascularresistance, MVO2, pulmonary artery pressures, and pulmonary artery wedgepressure after four weeks

d) Hospitalizations and changes in medication dosages for the treatmentof CHF over 12 weeks

e) Blood pressure and heart rate at four and 12 weeks

f) Six-Minute Walk Test after four weeks and 12 weeks

g) Left ventricular ejection fraction, left ventricular end systolic,and left ventricular end diastolic volumes at 12 weeks.

Samples of blood were collected from patients from a peripheral vein,whilst they were supine, at 2 hours post-dose during weeks 4 and 12.Further samples from supine patients were collected on day 0 (i.e. theday prior to the start of dosing) at a time corresponding to 2 hourspost-dose. In addition, a group of patients underwent right heart andcoronary sinus catheterization during week 4 at 2 hours post-dose and onday 0 (i.e. the day prior to the start of dosing) at a timecorresponding to 2 hours post-dose. Triplicate samples of blood werecollected from the arterial vein and coronary sinus of these patients.

Concentrations of the free base of dopamine and norepinephrine weredetermined by a radioenzymatic method. The method involves theincubation of the plasma samples with catechol-O-methyl transferase andtritiated S-adenosyl methionine. On completion of the incubation, theO-methylated catecholamines are extracted from the plasma byliquid/liquid extraction and then separated by thin layerchromatography. The relevant bands for each catecholamine are marked andthen scraped into scintillation vials for counting. The quantitationlimit of the method is 1 pg of dopamine or norepinephrine per mL ofplasma. The linear range is 1 to 333000 pg of dopamine or norepinephrineper mL of plasma using aliquots of 0.045 mL to 1 mL.

A pooled human plasma sample was used as the Quality Control sample (QC)and was analyzed in singlicate each day during routine use of the methodto monitor the performance of the method.

Example 8

Preclinical in vitro and in vivo pharmacology studies were conductedwith nepicastat. The in vitro studies assessed the ability of thecompound to inhibit DBH activity, and its binding affinity at selectedreceptors. The in vivo studies are subdivided into four categories: 1)biochemical effects (i.e. the ability to decrease tissue norepinephrinelevels and increase dopamine levels), 2) effects on thyroid function, 3)cardiovascular effects, and 4) behavioral effects.

Nepicastat was a potent inhibitor of both bovine and human DBH. The IC₅₀for nepicastat on human DBH was 9 nM (CL 6960), significantly lower thanthat for the DBH inhibitor SKF-102698 (85 nM). The S enantiomernepicastat was more potent than the R enantiomer (18 nM), denoted asCompound B.

The binding affinity for nepicastat was screened at selected receptors.Nepicastat showed a binding affinity of less than 5.0 for M1, D1 and D2,and 5HT1A, 2 _(A) and 2c. The N-acetyl metabolite of nepicastat in ratsand monkeys, showed a similar lack of binding affinity for thesereceptors. Thus nepicastat and its primary metabolite were not potentinhibitors for the receptors listed above.

The aortic contractile response in vitro to phenylephrine is impaired inspontaneously hypertensive rats (SHRs) relative to normotensiveWistar-Kyoto rats. Daily treatment with nepicastat (10 mg/kg, p.o.) inSHRs for 21 days restored phenylephrine responsiveness to valuescomparable to the Wistar-Kyoto rats.

Overall, nepicastat was an effective inhibitor of DBH in rats and dogs.Oral or intravenous administration resulted in a significant (p<0.05)decrease in tissue norepinephrine, an increase in dopamine, and anincrease in the dopamine/norepinephrine levels in the heart, mesentericor renal artery, and the cerebral cortex in both species.

In studies with male spontaneously hypertensive rats (SHRs), nepicastatsignificantly decreased norepinephrine and increased dopamine and thedopamine/norepinephrine ratio in the mesenteric artery from 0.5 to 4hours following oral or i.v. administration at 6.2 mg/kg. Significantchanges in these parameters were also observed in the left ventricle ofmale Sprague-Dawley rats 6 hours after the second of two i.v. injections(15 mg/kg) given 12 hours apart. The 24 hour time course of tissuecatecholamines was studied in male SHRs following oral administration ofeither 10 or 30 mg/kg, respectively. The increase in thedopamine/norepinephrine ratio was significant at 1 hour, and was longlasting (12 hours at 10 mg/kg, mesenteric artery, and 24 hours at 30mg/kg, left ventricle). Significant changes in mesenteric arterydopamine and norepinephrine levels were observed following 10 days ofdosing to male Sprague-Dawley rats at 2.0 and 6.2 mg/kg p.o. b.i.d.,with no significant effects observed in the cerebral cortex. SHRs dosedat 1 or 10 mg/kg/d p.o. for either 7 or 25 days had significantincreases in dopamine and the dopamine/norepinephrine ratio in themesenteric artery and cerebral cortex. Taken together, nepicastatresulted in a significant decrease in norepinephrine and an elevation indopamine and the dopamine/norepinephrine ratio in the mesenteric arteryin rats with either acute or chronic (up to 25 days) dosing.

The effects of nepicastat in male SHRs and Sprague-Dawley rats werefound to be dose responsive when assessed 6 hours following a singleoral dose at 0.3, 1, 3, 10, 30, and 100 mg/kg. In SHRs there weresignificant changes in the dopamine/norepinephrine ratio in themesenteric artery at doses of 0.3 mg/kg, in the left ventricle at 3.0mg/kg, and in the cerebral cortex at 10 mg/kg. In Sprague-Dawley ratsthere were significant increases in the dopamine/norepinephrine ratio inthe mesenteric artery at 3.0 mg/kg, in the left ventricle at 1.0 mg/kg,and in the cerebral cortex only at 100 mg/kg. In a second dose-responsestudy in SHRs, three doses were administered 12 hours apart at either3.0, 10, 30, or 100 mg/kg, and tissue was harvested six hours after thethird dose. Nepicastat caused a significant dose dependent decrease innorepinephrine (10 mg/kg) and increase in dopamine (3.0 mg/kg) and thedopamine/norepinephrine ratio (3.0 mg/kg) in the left ventricle andmesenteric artery. The effects of nepicastat on dopamine andnorepinephrine concentrations, and the dopamine/norepinephrine ratio inthe cerebral cortex were significant only at 30 and 100 mg/kg. Similarsignificant dose-response effects in the left ventricle were seen infemale Wistar rats dosed with nepicastat for 7 days via the drinkingwater (0.3, 0.6, and 1.0 mg/ml). In conclusion, nepicastat was lesspotent in inhibiting DBH in the cerebral cortex of rats (60-100 mg/kg/d)than in the left ventricle and mesenteric artery (1-6 mg/kg/d).

Nepicastat (the S enantiomer) was significantly more potent then the Renantiomer in the left ventricle and mesenteric artery in SHRs afterthree doses given 12 hours apart (30 mg/kg p.o.). nepicastat wassignificantly more potent than the DBH inhibitor SKF-102698 indecreasing norepinephrine and increasing dopamine and thedopamine/norepinephrine ratio in the left ventricle and mesentericartery in SHRs after a single dose, or three doses at 30 mg/kg. Thepotency relationships in the left ventricle and mesenteric arteryresulting from these in vivo studies strongly parallel those obtainedfrom in vitro studies using purified DBH (see above). However,nepicastat had significantly less effects than SKF-102698 in decreasingnorepinephrine levels and increasing dopamine levels in the cerebralcortex. Norepinephrine has been shown to stimulate the release of reninand increase plasma renin activity. It was therefore of interest toassess whether decreasing norepinephrine levels with nepicastat wouldresult in a decrease in plasma renin activity. However, nepicastat (30and 100 mg/kg/d p.o. for 5 days) did not alter plasma renin activity inmale SHRs. Thus, nepicastat, when given at doses that lower tissuenorepinephrine levels, does not alter plasma renin activity in SHRs.

Nepicastat caused a significant decrease in norepinephrine levels and anincrease in the dopamine/norepinephrine ratio, but did not alterdopamine levels, in the mesenteric artery from male beagle dogs 5 hoursafter administration of 30 mg/kg intraduodenally. When nepicastat wasgiven to male beagle dogs for 4.5 days (5, 15, and 30 mg/kg b.i.d., or10, 30, and 60 mg/kg/d) there was a significant decrease innorepinephrine, and an increase in dopamine and thedopamine/norepinephrine ratio in the renal artery, renal cortex, andrenal medulla, with a plateau in response beginning at 10 mg/kg/d andextending through 60 mg/kg/d. Similar results were observed in the leftventricle, except that there was no significant increase in dopamine. Inthe cerebral cortex, norepinephrine significantly decreased at 30 and 60mg/kg/d, and dopamine and the dopamine/norepinephrine ratiosignificantly increased at all doses. In conclusion, nepicastat was apotent, orally active inhibitor of DBH in dogs at doses of at least 10mg/kg/d.

Nepicastat has structural similarities to methimazole, a potentinhibitor of thyroid peroxidase in vivo. nepicastat at doses of 4 or12.4 mg/kg/d, p.o. had no effect on serum levels of triiodothyramine orthyroxine in male Sprague-Dawley rats fed a low iodine diet and dosedfor 10 days, while methimazole (2 mg/kg/d) significantly reduced serumlevels of triiodothyramine or thyroxine. Thus, nepicastat, unlikemethimazole, did not affect serum levels of triiodothyramine orthyroxine.

Nepicastat induced a significant antihypertensive effect for up to 4hours in conscious, restrained SHRs (1.0-30 mg/kg, p.o.), andsignificantly reduced heart rate (10 and 30 mg/kg). The antihypertensiveeffects of nepicastat in conscious, restrained SHRs (10 mg/kg, p.o.)were not attenuated by pretreatment with the dopamine receptor (DA-1)antagonist SCH-23390. nepicastat (10 mg/kg) also reduced blood pressure4 hours after dosing in conscious, restrained normotensive Wistar-Kyotorats; however, the decrease in pressure was less (−13 mmHg) than withSHRs (−46 mmHg). To summarize together, nepicastat causes a decrease inblood pressure in both SHRs and normotensive rats, though theantihypertensive effect is more pronounced in SHRs. The antihypertensiveeffects in SHRs do not appear to be mediated via DA-1 receptors.

Nepicastat also significantly attenuated the hypertensive andtachycardic responses to preganglionic nerve stimulation in pithed SHRs5 hours after dosing (3 mg/kg p.o.). Thus, nepicastat reduces the risein blood pressure in response to sympathetic nerve stimulation.

Acute intravenous treatment of anesthetized SHRs with nepicastat (3.0mg/kg, i.v.) decreased mean arterial pressure over a 3 hour period, butdid not lower renal blood flow or alter urine production or urinaryexcretion of sodium or potassium. The calculated renal vascularresistance was decreased following dosing. An attempt was made using theDA-1 antagonist SCH-23390 to assess if the renal vasodilator effects ofnepicastat were mediated by DA-1 receptors. However this compoundreduced blood pressure when given alone, thus making the resultsuninterpretable. Overall, nepicastat did not impair renal function inanesthetized SHRs, and did not decrease renal blood flow despite causinga decrease in arterial blood pressure.

Daily treatment with nepicastat (1 and 10 mg/kg, p.o.) in SHRs for 21days did not alter heart rate, or systolic blood pressure as measured bythe tail cuff method. However, nepicastat (10 mg/kg, p.o.) induced asignificant antihypertensive effect when the rats were restrained andtheir blood pressure measured directly via an arterial cannulae.

Nepicastat significantly lowered blood pressure in SHRs instrumentedwith radio-telemetry blood pressure transducers at doses of 30 and 100mg/kg/d for 30 days, but produced no significant effects were observedat 3 and 10 mg/kg/d. The effect at 30 and 100 mg/kg/d persisted over a24-hour period after a single dose, and there was no loss of effect over30 days. Heart rate was not increased, and motor activity wasunaffected. A combination of a dose of the angiotensin converting enzymeinhibitor enalapril (1 mg/kg, p.o.) that failed to lower blood pressurewith nepicastat (30 mg/kg) caused a potentiation of the antihypertensiveeffects of nepicastat over 30 days of dosing, and resulted in asignificant reduction in left ventricular mass. A reduction in leftventricular mass did not occur with enalapril alone. Thus, 30 days oftreatment of SHRs with nepicastat at 30 and 100 mg/kg/d resulted in adecrease in blood pressure and, when combined with enalapril, additionalblood pressure decreases along with a reduction in left ventricularmass.

The blood pressure lowering effect of nepicastat in normotensive Wistarrats instrumented with radio-telemetry blood pressure transducers wasless than the effect observer in SHRs at doses of 30 and 100 mg/kg/d for7 days. At 30 mg/kg/d the peak decrease in blood pressure was −10 mmHg,compared to −20 in SHRs. At 100 mg/kg/d the peak decrease in bloodpressure was −17 mmHg, compared to −42 in SHRs. Thus, nepicastat had agreater blood pressure lowering effect in SHRs than in normotensiverats.

Studies in normal anesthetized dogs showed no cardiovascular effects ofnepicastat following acute intravenous dosing (1-10 mg/kg i.v.) with nochanges in arterial blood pressure, left ventricular pressures(including peak dp/dt), heart rate, cardiac output or renal blood flowfor up to five hours after dosing. A similar lack of effect was observedin chronically instrumented, conscious dogs studied for 12 hours after asingle dose (3-30 mg/kg i.v.).

Nepicastat (30 mg/kg intraduodenally) did not significantly inhibiteither the decrease in renal blood flow in response to direct renalnerve stimulation, or the increase in arterial blood pressure inresponse to carotid artery occlusion up to 5 hours after dosing inanesthetized male beagle dogs. However, nepicastat caused a significantdecrease in norepinephrine levels and an increase in thedopamine/norepinephrine ratio, but not dopamine levels, in themesenteric artery 5 hours after dosing. Thus, although tissuenorepinephrine levels were significantly reduced, there was nosignificant inhibition of sympathetically-evoked functional responses.

When nepicastat was given to male beagle dogs for 4.5 days at 10 mg/kg/dthere was no statistically significant decrease in the degree of bloodpressure and heart rate increases in response to carotid arteryocclusion in anesthetized animals. Nepicastat treatment significantlyreduced the increase in heart rate in response to an i.v. tyraminechallenge, but produced only slight and non-significant inhibition ofblood pressure increases. Thus, chronic dosing with nepicastat at a dosethat has been shown to result in a maximal decrease in tissuenorepinephrine levels, does not have a major inhibitory effect onsympathetically-evoked functional responses.

Nepicastat caused no significant effects on gross motor behavior in micefollowing acute dosing at 1.0-30 mg/kg, p.o., and it did not effectlocomotor activity in mice (10-100 mg/kg i.p.). Acute administration torats did not effect locomotor activity or acoustic startle reactivity(3-100 mg/kg i.p.).

No behavioral effects were observed in rats following 10 days of dosingat 10, 30, and 100 mg/kg/d, p.o. Rectal temperature was also unaffected.Motor activity and auditory startle reflex were significantly reduced bytreatment with the DBH inhibitor SKF-102698 (100 mg/kg/d, p.o.), and bythe centrally acting a-adrenergic agonist clonidine (20 mg/kg, b.i.d.,p.o.). Motor activity was also unaffected over 30 days of dosing in SHRs(3-100 mg/kg/d, p.o.). Thus, nepicastat did not cause detectable changesin central nervous system mediated behavioral effects in rats.

Nepicastat is a potent competitive inhibitor of human DBH in vitro, andin rats and dogs in vivo. In rats, oral treatment with nepicastatresulted in significant evidence for DBH inhibition in the heart andmesenteric artery at a dose 6 mg/kg/d. In contrast to another DBHinhibitor, SKF-102698, nepicastat showed some selectivity to the leftventricle and mesenteric artery relative to the cerebral cortex. Nobehavioral effects were observed with nepicastat in rats. In dogs, aplateau effect for DBH inhibition occurred at 10 mg/kg/d in the heart,renal artery and kidney. Nepicastat significantly reduced thehypertensive response to sympathetic nerve stimulation in rats (3 mg/kgp.o.), and it significantly lowered blood pressure throughout the daywhen dosed once daily (30 mg/kg/d p.o.) for 30 days in SHRs. Inconclusion, nepicastat is a potent DBH inhibitor that modulates theaction of the sympathetic nervous system.

Example 9

The studies described here were designed to evaluate thepharmacokinetics of higher oral doses of nepicastat, to compare thepharmacokinetics in male and female rats, and to determine penetrationof nepicastat into the CNS by quantitating levels of nepicastat inbrain.

Male rats (Crl: CD BR Vaf+) weighing 180-220 g were fasted overnightbefore dosing and until 4 hr after dosing. Doses were formulated inwater containing 2% 1-hydroxypropyl methylcellulose (50 centipoisesviscosity), 1% benzyl alcohol, and 0.6% Tween 80 (all obtained fromSigma Chemical Company). Concentration of drug in the dose solutions was5, 15, and 50 mg/ml for the 10, 30, and 100 mg/kg doses, respectively,and was verified by liquid chromatography (LC). The 5 mg/ml dose was aclear solution and the higher concentrations were a translucentsuspension. Dose volumes were 2.0 ml/kg. At various times after dosing,samples of blood were obtained by cardiac puncture with heparinizedsyringes, and plasma was prepared by centrifugation. Brains of rats weresurgically excised, and all samples were frozen at −20° C. untilanalysis.

Aliquots of plasma (0.05 or 0.5 ml) were mixed with internal standard(50 μl of methanol containing 5 g/ml a monofluoro analog of nepicastat,and 5 mg/ml dithiothreitol). Samples were mixed with 200 mM sodiumphosphate buffer, pH 7.0, (0.5 ml) and extracted with 3 ml of ethylacetate/hexane (1/1, v/v). The organic phase containing analytes wasback extracted with 250 μl of 250 mM acetic acid and 100 μl aliquots ofthe aqueous phase were assayed by LC. The LC system used a KeystoneHypersil BDS 15 cm C8 column at ambient temperature. Mobile phase A was12.5 mM potassium phosphate, pH 3.0, with 5 mM dodecanesulfonic acid andmobile phase B was acetonitrile. Solvent composition was 40% B and waspumped at a flow rate of 1 ml/min. Detection was by UV absorption at 261nm. Concentrations of analytes were determined from a standard curvegenerated from the analysis of plasma from untreated rats fortified withknown concentrations of analyte. Plasma concentration data are expressedas g (free base) per ml.

Brains were rinsed briefly with saline, blotted on a paper towel, thenweighed (1.5-2.0 g). Internal standard was added (50 μl of methanolcontaining 20 μg/ml a monofluro analog of nepicastat), and brains werehomogenized in 5 ml of 200 mM sodium phosphate, pH 7.0, containing 0.5mg/ml dithiothreitol. Aliquots of homogenate (2 ml) were extracted with10 ml of ethyl acetate/hexane (1/1, v/v). The organic phase was gentlyback extracted with 150 of 250 mM acetic acid.

Following addition of 100 μl of methanol to the aqueous phase (todisperse any emulsion), 100 μl aliquots were assayed by LC as describedfor plasma. Level in brain are expressed as g (free base) per g of braintissue.

Pharmacokinetic parameters were calculated from mean plasmaconcentrations. Plasma half-life (T_(1/2)) was calculated as 0.693/β,where β is the elimination rate constant determined by linear regressionof the log plasma concentration vs. time data within the terminal linearportion of the data. Areas under the plasma concentration vs. time curve(AUC) from zero to the time of the last quantifiable plasmaconcentrations were calculated by the trapezoidal rule. AUC from zero toinfinity (AUC_(total)) was calculated as:

AUC_(total)=AUC(0-C_(last))+C_(last)/β where C_(last) is the lastquantifiable plasma concentration.

Concentrations of nepicastat in plasma of male rats given 10, 30, or 100mg/kg single oral doses were obtained. Concentrations of nepicastat inplasma increased with increasing dose, and the relationship betweenAUC_(total) and dose was linear. The elimination half-life appeared toincrease slightly at higher doses (1.70, 2.09, and 3.88 hr following the10, 30, and 100 mg/kg oral doses to male rats, respectively). Followinga 30 mg/kg oral dose of nepicastat to female rats, the plasmaAUC_(total) of nepicastat was 77% higher in female rats than in malerats given an equivalent dose of nepicastat. Levels of nepicastat inbrain (expressed as g/g) were initially lower than those in plasma(expressed as g/ml). From 2 hr following dosing onward, however,concentrations of nepicastat in brain exceeded those in plasma.

Plasma levels of nepicastat in male rats increased linearly withincreasing doses between 10 and 100 mg/kg, based on values ofAUC_(total).

Plasma levels of nepicastat were higher in female rats than in male ratsfollowing a 30 mg/kg oral dose.

Following administration of a 10 mg/kg oral dose of nepicastat to malerats, levels of nepicastat in brain were initially lower than those inplasma, but from 2 hr onward, levels of nepicastat in brain were greaterthan in plasma.

Example 10

The purpose of this study was to determine the 24 hours time course ofthe effects of nepicastat (10 mg/kg) on dopamine and norepinephrinelevels in the mesenteric artery following a single oral dose inspontaneously hypertensive rats. Catecholamine levels were measured at1, 2, 4, 6, 8, 12, 16, and 24 hours after a single oral administrationof either nepicastat (10 mg/kg) or vehicle (dH₂O; 10 ml/kg).

Sixteen-17 week old, male spontaneous hypertensive rats (SHRs) weighing300-400 grams were allowed food and water ad libitum. Animals wereweighed and randomly assigned, the afternoon before the study, to one ofthe following treatment groups (n=9 per group): a single oraladministration of nepicastat at 10 mg/kg or a single oral administrationof vehicle (10 ml/kg) to be sacrificed at 1, 2, 4, 6, 8, 12, 16, or 24hours.

Nepicastat was synthesized as the hydrochloride salt and nepicastat wasdissolved in vehicle (dH₂O) to yield an oral dose that could beadministered in repeated volumes of 10 ml/kg. All doses of nepicastatwere administered as free base equivalents and prepared the morning ofadministration.

Animals were dosed every minute the morning of sacrifice. At 1, 2, 4, 6,8, 12, 16 and 24 hours following administration, 9 treated animals and 9vehicle animals were anesthetized with halothane, decapitated, and theleft ventricle and mesenteric artery were rapidly harvested and weighed.The mesenteric artery was put in 0.5 ml of 0.4M perchloric acid in acentrifuge tube and the left ventricle put into an empty cryotube. Bothtissues were immediately frozen in liquid nitrogen and stored at −70° C.Mesenteric artery catecholamine levels were determined using HPLC withelectrochemical detection. At the time of decapitation, plasma sampleswere taken by draining blood from the carcass into a tube containingheparin, and centrifuging at 4° C.

Each treatment group was compared to vehicle at each time point. A twoway analysis of variance (ANOVA) with effects TRT, HARVEST and theirinteraction was performed. A one way ANOVA with factor TRT was performedfor each harvest time. Pairwise analyses between treated and vehicleanimals, at each time point, were carried out using Fisher's LSDstrategy to control the experiment-wise error rate. Norepinephrinevalues were significantly (p<0.05) lower than vehicle only at the 4 hrtime point. Levels were marginally (0.05<p<0.1) lower at the 6 hour timepoint. Dopamine levels were significantly (p<0.05) higher than those ofvehicle at the 2 and 6 hr harvest times. The dopamine/norepinephrineratio was significantly (p<0.05) greater than those of vehicle treatedanimals at the 1, 2, 4, 6 and 12 hour time points.

In general, nepicastat had few statistically significant effects onmesenteric artery norepinephrine or dopamine levels following a singleoral administration at 10 mg/kg in spontaneously hypertensive rats at 1,2, 4, 6, 8, 12, 16 or 24 hours following dosing. However, a consistentincrease in the dopamine/norepinephrine ratios were observed across mostof the first 12 hours of treatment. At the 16 and 24 harvest time nochanges in any of the three parameters were observed.

Example 11

The purpose of this study was to determine the effects of intravenousadministration of nepicastat (hereafter referred to as nepicastat) onthe levels of dopamine and norepinephrine in the left ventricle inSprague-Dawley rats. Animals received two intravenous (iv)administrations, 12 hours apart, of either vehicle (75% propyleneglycol+25% DMSO; 1.0 ml/kg) or 15 mg/kg of nepicastat. Tissuenorepinephrine and dopamine levels were measured six hours after thelast compound administration.

Sixteen to 17 week old male Sprague-Dawley rats, weighing 300-400 grams,were allowed food and water ad libitum. Animals were weighed andrandomly assigned, the afternoon before the study, to one of thefollowing treatment groups (n=10 per group): vehicle (1.0 ml/kg) ornepicastat at 15 mg/kg.

Nepicastat was synthesized and was dissolved in the appropriate amountof vehicle (75% propylene glycol+25% DMSO) to obtain a dosing volume of1.0 ml/kg. Nepicastat was administered as the free base equivalent andprepared the afternoon prior to the first administration.

Each rat was dosed iv in the tail vein the afternoon before harvest. Thedosing was repeated 12 hours later the following morning. Six hoursafter the final administration rats were anesthetized with halothane,decapitated, and the left ventricle was rapidly harvested and weighed.The ventricle was placed in 1.0 ml iced 0.4 M perchloric acid. Tissueswere immediately frozen in liquid nitrogen and stored at −70° C. Tissuedopamine and norepinephrine concentrations were assayed by highperformance liquid chromatography using electrochemical detection.

A one-way analysis of variance (ANOVA) with a main effect for treatmentwas performed for norepinephrine. A Kruskal-Wallis was performed fordopamine and their ratio primarily due to heterogeneous variances amongtreatment groups. Subsequent pairwise comparisons between nepicastattreated rats and vehicle were performed using Fisher's LSD test. ABonferroni adjustment was performed on all p-values to ensure an overallexperiment-wise type 1 error rate of 5%.

Nepicastat administered at 15 mg/kg significantly (p<0.01) decreasednorepinephrine levels by 51%, and significantly (p<0.01) increaseddopamine levels by 472%, and significantly (p<0.01) increased thedopamine/norepinephrine ratio by 1117%, compared to vehicle treatedanimals.

In conclusion, intravenous administration of nepicastat resulted insignificant inhibition of DBH in the left ventricle of Sprague-Dawleyrats.

Example 12

This study assessed the effectiveness of nepicastat in altering thelevels of dopamine and norepinephrine in the cortex, left ventricle, andmesenteric artery of male spontaneously hypertensive rats (SHRs).Animals were given three doses, 12 hours apart at 3, 10, 30 or 100 mg/kgp.o.

This study also compared the efficacy of the S enantiomer (nepicastat)with the R enantiomer (Compound B) following three doses (30 mg/kg).This study also compared the effects of nepicastat with SKF-102698, aDBH inhibitor previously shown to be orally active in rats.

Compounds were prepared and administered as the free base equivalent.Nepicastat was dissolved in the appropriate amount of vehicle (dH₂O fornepicastat and PEG 400:dH₂O, 50:50 vol:vol for SKF-102698. Doses of 3,10, 30, and 100 mg/kg of nepicastat, and 30 mg/kg SKF-102698 wereprepared in 10.0 ml/kg dosing volumes.

Fifteen to sixteen week old male spontaneously hypertensive rats (SHRs)(Charles River Labs) were allowed food and water ad libitum. Animalswere weighed and randomly assigned to one of the following treatmentgroups: 1) distilled water vehicle (dH₂O), or nepicastat at 3, 10, 30,and 100 mg/kg, 2) Compound B at 30 mg/kg in distilled water, or 3) PEG400:dH₂O vehicle or SKF-102698 at 30 mg/kg. Each rat was dosed orally(p.o., using a gavage needle) three times 12 hours apart, beginning inthe morning. At six hours after the third dose rats were anesthetizedwith halothane, decapitated, and the cortex, mesenteric artery, and leftventricle were rapidly harvested, weighed, placed in iced 0.4 Mperchioric acid, frozen in liquid nitrogen, and stored at −70° C. Tissuedopamine and norepinephrine concentrations were assayed by highperformance liquid chromatography and electrochemical detection.

Four series of statistical analyses were performed. The first seriescompared the rats treated with various doses of nepicastat, and CompoundB at 30 mg/kg to the vehicle control animals. A nonparametric one-wayanalysis of variance (ANOVA) with factor Dose and blocking factor Daywas performed for each tissue and strain separately. Overall results arereported. Pairwise analysis between treated and controls at each dosewere carried out using Dunnett's test to control the experiment-wiseerror rate. The second statistical test compared SKF-102698 to thePEG-dH₂O vehicle treated group using a nonparametric t-test. The thirdstatistical test compared Compound B to nepicastat at doses of 30 mg/kgusing a nonparametric t-test. A fourth statistical analysis comparednepicastat to SKF-102698 at doses of 30 mg/kg. Since two differentvehicles were used, a linear contrast was developed which calculates thedifference of differences as follows:

Change=(30 mg/kg−Vehicle)_(NEPICASTAT)−(30 mg/kg−Vehicle)_(SKF-102698)

This new variable was tested for equality to zero by the SAS procedureGeneral Linear Models.

The dopamine concentration in the cerebral cortex was significantly(p<0.05) greater, the norepinephrine concentration was significantly(p<0.05) lower), and the dopamine/norepinephrine ratios significantly(p<0.05) greater than vehicle at doses of 30 and 100 mg/kg ofnepicastat.

Dopamine concentration in the left ventricle was significantly (p<0.05)greater than vehicle at doses of 3, 10, 30 and 100 mg/kg. Norepinephrineconcentration was significantly (p<0.05) lower than vehicle at doses of10, 30 and 100 mg/kg. The dopamine/norepinephrine ratio in the leftventricle was significantly (p<0.05) greater than vehicle at doses of 3,10, 30, and 100 mg/kg of nepicastat.

Dopamine concentration in the mesenteric artery of SHRs wassignificantly (p<0.05) greater than vehicle at doses of 3, 10, 30 and100 mg/kg. Norepinephrine concentration was not significantly less(p>0.05) than vehicle at 10, 30, and 100 mg/kg. Thedopamine/norepinephrine ratios in the mesenteric artery weresignificantly (p<0.05) greater than vehicle at all doses of nepicastat.

In the cerebral cortex, relative to treatment with vehicle, Compound Bresulted in significant increase in both dopamine and norepinephrine(p<0.01), and had no effect on the dopamine/norepinephrine ratio.Norepinephrine levels were significantly lower with nepicastat comparedto Compound B (p<0.01).

In the left ventricle, relative to treatment with vehicle, Compound Bresulted in a significant increase in dopamine and thedopamine/norepinephrine ratio (p<0.01), but did not significantly lowernorepinephrine levels. Nepicastat was significantly more effective(p<0.01) than Compound B at lowering norepinephrine levels, andincreasing dopamine and the dopamine/norepinephrine ratio.

In the mesenteric artery, relative to treatment with vehicle, Compound Bresulted in a significant increase in dopamine and thedopamine/norepinephrine ratio (p<0.01), but did not significantly lowernorepinephrine levels. Nepicastat was significantly more effective(p<0.01) than Compound B at lowering norepinephrine levels, andincreasing dopamine and the dopamine/norepinephrine ratio.

Comparing nepicastat with SKF-102698 at 30 mg/kg in the cerebral cortex,dopamine concentration in the cortex was significantly greater (p<0.01)than vehicle for SKF-102698 at a dose of 30 mg/kg. The increase abovevehicle was greater for SKF-102698 than for nepicastat (p<0.01).Norepinephrine concentration was significantly lower than vehicle forSKF-102698, and the decrease was greater for SKF-102698 than fornepicastat (p<0.01). The dopamine/norepinephrine ratios in the cortexwere significantly (p<0.01) greater than vehicle for SKF-102698, and theincrease above vehicle was greater for SKF-102698 than for nepicastat(p<0.01).

The dopamine concentration in the left ventricle was significantlygreater (p<0.01) than vehicle for SK-F102698, and the increase abovevehicle was greater for nepicastat than for SKF-102698 (p<0.01).Norepinephrine concentration was not different from vehicle withSKF-102698 treatment, however treatment with nepicastat significantlylowered norepinephrine relative to vehicle more than SKF-102698(p<0.01). The dopamine/norepinephrine ratios in the left ventricle weresignificantly (p<0.05) greater than vehicle for SKF-102698, and theincrease above vehicle was greater for nepicastat than for SKF-102698(p<0.05).

The dopamine concentration in the mesenteric artery was significantlygreater than vehicle for SKF-102698, and the increase above vehicle wasgreater for NEPICASTAT than for SKF-102698. Norepinephrine concentrationwas significantly lower than vehicle with SKF-102698 treatment, andtreatment with nepicastat significantly lowered norepinephrine relativeto vehicle more than SKF-102698. The dopamine/norepinephrine ratios inthe left ventricle were significantly greater than vehicle than forSKF-102698, and the increase above vehicle was greater for nepicastatthan for SKF-102698.

In conclusion, the data show that nepicastat is a potent inhibitor ofDBH in vivo in the mesenteric artery, left ventricle, and cerebralcortex of SHRs six hours after the third of three oral dosesadministered 12 hours apart. The S enantiomer, nepicastat was morepotent than the R enantiomer (Compound B) in all three tissues at 30mg/kg. Furthermore, nepicastat was more effective than SKF-102698 in themesenteric artery and left ventricle, but less effective in the cerebralcortex, following three doses at 30 mg/kg administered over 24 hours.

Example 13

Nepicastat was prepared and administered as the free base equivalent.Nepicastat and methimazole were dissolved in vehicle (66.7% propyleneglycol:33.3% dH₂O) to yield dosing solutions of appropriateconcentrations so that all doses could be administered in a 1.0 ml/kgvolume.

Male Sprague-Dawley rats, weighing 180-200 grams, were fed an iodinedeficient diet (Purina, 5891C, Lot 1478, 0.066±0.042 mg iodine/kgsample) ad libitum 14 days prior to treatment. Animals were weighed andrandomly assigned to one of the following treatment groups (n=12 pergroup): nepicastat at 2.0 mg/kg, nepicastat at 6.2 mg/kg, Methimazole at1 mg/kg, or vehicle at 1 ml/kg. Each group of rats was dosed orally inthe evening and the following morning, approximately 12 hours apart, for10 consecutive days.

At four hours after the second dose, on day 10, rats were anesthetizedwith halothane, decapitated, and the cortex, striatum, and mesentericartery were harvested and weighed. Tissue samples were not harvestedfrom the methimazole groups as they only served as positive controls fordetermination of thyroid function. The mesenteric artery, cortex, andstriatum were immediately placed in 0.4 M iced perchloric acid andanalyzed for norepinephrine and dopamine levels the same day using HPLC.

Orbital blood samples were taken at day −3, 0, 3, 7, and 9 (day 0 wasthe first day of dosing). Serum samples were analyzed for T₃ and T₄levels using a radioimmunoassay.

To statistically evaluate changes in T₃ and T₄ levels, a change frombaseline was calculated from the day −3 time point. A non-parametrictwo-way within subject analysis of variance (ANOVA) was conducted. Alsoa one-way ANOVA was performed to detect if a significant difference fromcontrol occurred. Pairwise analyses between controls and each treatmentgroup were carried out using Fisher's LSD strategy to control theexperiment-wise error rate. For statistical analysis of catecholaminelevels, a one-way ANOVA with factor DOSE was performed. Pairwiseanalyses between treated and controls at each dose were carried outusing Fisher's LSD strategy to control the experiment-wise error rate.

Norepinephrine levels in the nepicastat treated animals were notsignificantly (p>0.05) different in the cortex compared to vehiclecontrol at doses of 2.0 and 6.2 mg/kg. Norepinephrine levels in themesenteric artery were significantly (p<0.05) lower at the 2.0 and 6.2mg/kg dose groups, and norepinephrine levels in the striatum weremarginally (p<0.10) lower in both the 2.0 and 6.2 mg/kg dose groups,compared to vehicle control.

Dopamine levels in all three tissues were not significantly (p>0.05)different from vehicle control at either the 2.0 or 6.2 mg/kg dose groupof nepicastat.

The dopamine/norepinephrine ratio of the cortex and striatum at 2.0 and6.2 mg/kg nepicastat were not significantly (p>0.05) different fromvehicle control, while the ratio of the mesenteric artery at both 2.0and 6.2 mg/kg nepicastat were significantly (p<0.05) higher than vehiclecontrol.

Neither 2.0 or 6.2 mg/kg nepicastat affected thyroid function byaltering free T₃ or total T₄ levels in the rat serum. A dose of 1.0mg/kg of Methimazole, the positive control, significantly (p<0.05)lowered T₃ levels on all treatment days and T₄ levels at day 3 and 7,compared to vehicle control. T₄ levels of the methimazole treatedanimals were only marginally (p<0.10) lower on day nine.

Nepicastat (2.0 or 6.2 mg/kg) did not cause any significant (p>0.05)changes in dopamine or the norepinephrine levels, ordopamine/norepinephrine ratio when compared to vehicle. In the striatum,a marginally significant (p<0.10) decrease in norepinephrine level wasobserved in the 6.2 mg/kg dose group, but no other significant changeswere observed. In the mesenteric artery, both 2.0 and 6.2 mg/kg ofnepicastat produced significantly (p<0.05) lower norepinephrine levelsand significantly (p<0.05) higher dopamine/norepinephrine ratios,compared to vehicle, with no significant changes observed in dopaminelevels. Thus nepicastat appears to be an effective inhibitor of dopamineβ-hydroxylase in vivo, with greater effect in the mesenteric artery thanthe cerebral cortex or striatum following 10 days of dosing inSprague-Dawley rats.

Example 14

This study was performed to determine the dopamine and norepinephrineconcentrations in kidney medulla and kidney cortex from dogs dosed withnepicastat. Adult male beagle dogs were randomly assigned to four groupsof 8 dogs per group and dosed by oral administration with nepicastat.Nepicastat was delivered in doses of 5, 15 and 30 mg/kg placed in singlecapsules. Vehicle was an empty capsule. Each dog received 2 doses daily,morning and afternoon (8-10 hours apart) for four days. On the fifthday, each dog received a single dose in the morning and the dogs wereeuthanized six hours after the last dose. Samples of kidney medulla andkidney cortex were rapidly harvested, weighed, placed in cold 0.4 Mperchloric acid, frozen in liquid nitrogen and stored at −70° C.

To quantitate concentrations of norepinephrine (NE) and dopamine (D),each tissue was homogenized by brief sonication in 0.4 M perchloricacid. After sonication, the homogenates were centrifuged at 13,000 rpmin a microfuge for 30 minutes at 4° C. An aliquot of each supernatantwas removed and spiked with 3,4-dihydroxybenzylamine (DHBA) as internalstandard. The extract from each sample was subjected to HPLC separationusing electrochemical detection. The method has a quantitation limit of2.0 ng/mL and a linear range of 2.0 ng/mL to 400 ng/mL for each analyte.

Each analyte determination was normalized to the weight of the tissuesample and expressed as g of analyte per gram of tissue. Theconcentrations of dopamine, norepinephrine and the ratio of dopamineconcentration to norepinephrine concentration (D/NE) were obtained foreach dog. In addition, the calculated means and standard deviations foreach analyte and D/NE ratio were provided for each treatment group.

Example 15

Male Beagle dogs (Marshall farms, North Rose, N.Y.) weighing between9-16 kg were used in the study. The animals were allowed water adlibitum and given food once daily at 10.00 AM. Animals were randomlyassigned to one of the following treatment groups (n=8/group): placebo(empty capsule), or nepicastat at 2 mg/kg b.i.d (4 mg/kg/day). Eachanimal received 2 doses daily, morning and afternoon (8-10 hours apart).Daily blood samples (10 ml) were drawn 6 h after the AM dose formeasurement of plasma levels of nepicastat and catecholamines. The bloodwas collected in tubes containing heparin and glutathione andcentrifuged at −4° C. within 1 h of collection. The plasma was separatedand divided into two samples, one for the measurement of plasmacatecholamines and the other for analysis of nepicastat.

Tissue samples were also taken from the dogs at the end of the study incase it was deemed necessary to analyze tissue catecholamines at a laterpoint. On day 15, 6 hours after the AM dose, a final blood sample (10ml) was taken. Dogs were anesthetized with sodium pentobarbital (40mg/kg, iv), placed on a necropsy table and euthanized with a secondinjection of pentobarbital (80 mg/kg,iv). A rapid bilateraltransthoracotomy and abdominal incision was performed. Biopsies weretaken from the renal artery and left ventricle. The skull was opened toexpose the frontal lobe of the cerebral cortex and a biopsy was taken.Tissue samples were weighed, placed on iced 0.4 M perchloric acid,frozen in liquid nitrogen and stored at −70° C. until analyzed.

Plasma norepinephrine (NE), dopamine (DA) and epinephrine (EPI) wereanalyzed by HPLC using electrochemical detection. Plasma concentrationof nepicastat was determined by HPLC using electrochemical detection.

The Box-Cox transformations indicated that the logarithm was anappropriate variance stabilizing transformation; hence all analyses wereperformed on the log-values. The BQL (below quantitation limit) in theDA concentration of dog 1 at day 10 was set to 0; In (0) was set tomissing. The analysis was performed using a mixed model (using PROCMIXED) with the day and treatment categorical variables being fixed andthe dog within treatment being a random factor. For the fixed effects,the interaction between the day and the treatment was included, sincethe difference between the drug and placebo groups varies from day today. Contrasts were calculated using the CONTRAST statement, whichcorrectly takes into account the error terms for each particularcontrast. In particular, the contrasts comparing the treatment group tothe drug group uses the dog mean square for its error term, while thecomparisons used to establish steady state are all within dogcomparisons, and require the error mean square.

The time period of steady state was calculated using the Helmerttransformation (cf. SAS PROC GLM manual). These transformations compareeach treatment mean with the average of the treatment means of the timepoints following. The steady state period is defined to start at thefirst time point following the maximum time at which the Helmertcontrast is statistically significant. However, since this method canfail to detect a smoothly changing process, as appears might be the casehere, the slope of the analyte concentration during the steady stateperiod also was calculated. The slope during the steady state period wascalculated for each dog individually, yielding one slope per animal.Univariate statistics on the slopes were then calculated, with Normaltheory confidence intervals built on the mean slope, and the hypothesisof slope equaling zero was tested, and its Normal theory p-value wascalculated. This slope analysis was used as the basis for determiningwhether the steady state period was a period of changing concentration.

When compared to the placebo group, nepicastat (2 mg/kg, b i d) producedsignificant decreases in plasma NE (2.1 fold) and EPI (1.91 fold) andsignificant increases in plasma DA (7.5 fold) and DA/NE ratio (13.6fold).

The peak decreases in plasma NE and EPI were observed at day 6 and day8, respectively, whereas the peak increases in plasma DA and DA/NE ratiowere observed at day 7 and day 6, respectively. The effects on plasmaNE, DA and EPI attained steady-state at approximately 4, 8 and 6 dayspost-dose, respectively. The changes in plasma DA and DA/NE ratio weresignificantly different from placebo on all days post-dose. The changesin plasma NE were significantly different from placebo on days 4-9 anddays 11-13 post dose. The changes in plasma EPI were significantlydifferent from placebo on days 7-9 and day 12 post-dose.

Administration of nepicastat (2 mg/kg, bid) produced significant plasmalevels of the drug on all days. The peak levels were observed at 2 dayspost-dose. No significant levels of the N-acetyl metabolite ofnepicastat were detected on any of the days.

Chronic (14.5 days) administration of nepicastat (2 mg/kg, bid, po)produced significant decreases in plasma NE and EPI and significantincreases in plasma DA and DA/NE ratio. These changes reflect inhibitionof the sympatho-adrenal system via inhibition of the enzyme dopamineβ-hydroxylase.

Example 16

Nepicastat was weighed and put into capsules (size 13-Torpac; EastHanover, N.J.) to yield doses of 5, 15, and 30 mg/kg per capsule (givenb.i.d. to yield doses of 10, 30 and 60 mg/kg/day). The initial dogweight was used to determine the dose for each animal. Dogs receiving 0mg/kg/day received empty capsules (placebo). All doses of nepicastatwere administered as free base equivalents.

Thirty-two male beagle dogs, weighing 10-12 kg, were randomly assignedto one of the following 4 treatment groups (n=8 per group): nepicastatat 0 mg/kg/day (placebo), 10 mg/kg/day (5 mg/kg b.i.d.), 30 mg/kg (15mg/kg b.i.d.), or 60 mg/kg/day (30 mg/kg b.i.d.). Dog numbers 1-16 wereassigned as dose group A and dog numbers 17-32 as dose group B. Theterminal surgery for tissue harvest was performed over 2 days with 16animals studied per day. Two or 3 days before the first compoundadministration each dog was weighed and skin regions overlying bothcephalic, saphenous and jugular veins were shaved. Dosing consisted oforal administration of one capsule with the second given 8-10 hr later.Dogs were dosed as scheduled on days 1-3. On day 4, prior to the AMdose, 3 ml of blood were obtained from a jugular vein for determinationof baseline plasma compound levels. The dog was then administered the AMdose, and at 1, 2, 4 and 8 hr following the dose additional 3 ml bloodsamples were collected for determination of plasma compound levels.Blood samples were put into tubes containing heparin, centrifuged at 4°C. and stored at −20° C. until analysis. The PM dose was thenadministered as scheduled. The AM dose was administered as scheduled onthe days of surgery. Approximately 6 hr after the AM dose, a final 3 mlblood sample was taken from the jugular vein for determination of plasmacompound levels. The dog was then anesthetized with pentobarbital Na(˜40 mg/kg), given i.v. in a cephalic or saphenous vein, and deliveredto the necropsy room where an additional dose of pentobarbital Na wasgiven (˜80 mg/kg, iv). The left ventricle, renal artery, kidney, renalmedulla, renal cortex and cerebral cortex were then rapidly harvested,weighed, put into 2 ml iced 0.4M perchloric acid, frozen in liquidnitrogen and stored at −70° C. until analysis for catecholamines by HPLCusing electrochemical detection. All tissue samples were divided into 2portions, the second of which were immediately frozen in liquid nitrogenand stored at −70° C. for determination of tissue compound levels. Athird transmural sample taken from the left ventricle was immediatelyfrozen in liquid nitrogen and stored at −70° C. for use in receptorbinding studies.

Ventricles were homogenized in 50 mM Tris-HCl, 5 mM Na₂EDTA buffer (pH7.4 at 4° C.) using a Polytron P-10 tissue disrupter (setting 10, 2×15second bursts). Homogenates were centrifuged at 500×g for 10 minutes andthe supernatants stored on ice. The pellets were washed by resuspensionand centrifugation at 500×g and the supernatants combined. The combinedsupernatants were centrifuged at 48,000×g for 20 minutes. The pelletswere washed by resuspension and centrifugation once in homogenizingbuffer and twice in 50 mM Tris-HCl, 0.5 mM EDTA buffer (pH 7.4 at 4°C.). Membranes were stored at −70° C. until required. Saturationexperiments were conducted using [³H] CGP-12177 in buffer containing 50mM Tris-HCl, 0.5 mM EDTA (pH 7.4 at 32° C.). Non-specific binding wasdefined by 10 μM isoproterenol. Total bound, non-specific bound andtotal count tubes were set up for eight concentrations of [³H] CGP-12177ranging from 0.016 nM to 2 nM. Samples were incubated at 32° C. for 60minutes. Samples were filtered over 0.1% PEI pre-treated GF/B glassfiber filtermats using a Brandel cell harvester. Samples wee washed withroom temperature water three times for 3 seconds. Aquasol scintillationfluid was added to each vial and radioactivity determined by liquidscintillation counting. Saturation binding isotherms were analyzed afterfirst converting total ligand concentrations to free ligandconcentrations (total−bound=free). Individual saturation isotherms werecompleted for each tissue. Membranes were assayed for protein using theBio-Rad protein binding method and using gamma globulin as the standard.Receptor densities were expressed, per mg protein, as mean for eachtreatment group. Tissue catecholamine levels were analyzed by comparingnepicastat-treated groups with the placebo (control) treated groups. Anonparametric one-way analysis-of-variance (ANOVA) with factor DOSE wasperformed for each tissue and each catecholamine measure separately.Pairwise analyses between treated and controls at each dose were carriedout using Dunnett's test to control the experiment-wise error rate.Student-Neuman-Kuels and Fisher's LSD tests were performed asvalidation. Analysis of tissue and plasma compound levels were performedin 2 ways. First, individual t-tests were run to compare each dose levelto a factored level of its partner dose for each parameter. For example,three times the level of compound present at 10 mg/kg in a particulartissue or plasma should be comparable to the compound level observed inthe 30 mg/kg group. Additionally, a linear orthogonal contrast wascalculated for all three doses within the context of a one-way ANOVA. Apaired t-test was used to determine any differences in binding betweenthe vehicle treated group and the 10 mg/kg/day nepicastat group.

Dogs were orally administered 0, 5, 15, or 30 mg/kg nepicastat capsulesb.i.d. to yield doses of 10, 30, and 60 mg/kg/day for 4.5 days andtissue was harvested 6 hr after the final administration. In the renalartery, nepicastat administered at doses of 10, 30 and 60 mg/kg/daysignificantly (p<0.01) decreased norepinephrine levels by 86%, 81% and85%, respectively. Dopamine levels were significantly (p<0.01) increasedat doses of 10, 30 and 60 mg/kg/day by 180%, 273% and 268%,respectively. Doses of 10, 30 and 60 mg/kg/day nepicastat significantly(p<0.01) increased the dopamine/norepinephrine ratio by 1711%, 1767% and1944%, respectively, compared to placebo. Following administration of 10and 60 mg/kg/day nepicastat, dopamine levels were significantly (p<0.01)increased 632% and 411%, respectively in the cerebral cortex. Thedopamine/norepinephrine ratio was significantly (p<0.01) increased 531%after 10 mg/kg/day nepicastat and 612% following administration of 60mg/kg/day nepicastat. Norepinephrine levels were not significantly(p>0.01) affected at these 2 doses. At 30 mg/kg/day, norepinephrine wassignificantly (p<0.01) reduced by 63% and the ratio significantly(p<0.01) elevated by 86%, while dopamine levels marginally (0.05<p<0.10)increased 174%, compared to placebo. Following administration of 10, 30and 60 mg/kg/day nepicastat, norepinephrine levels were significantly(p<0.01) decreased by 85%, 58% and 79%, respectively in the leftventricle. The dopamine/norepinephrine ratio significantly (p<0.01)increased 852%, 279% and 607%, respectively, compared to placeboanimals. No significant changes were observed in dopamine levels atdoses of 10, 30, and 60 mg/kg/day nepicastat.

In the renal cortex, compared to placebo, norepinephrine levels weresignificantly decreased (p<0.01) by 86%, 66% and 85%, respectively,following doses of 10, 30 and 60 mg/kg/day nepicastat. Dopamine levelswere significantly (p<0.01) increased 156%, 502% and 208%, respectively,at these doses. The dopamine/norepinephrine ratio significantly (p<0.01)increased by 1653%, 1440% and 1693%, respectively, at doses of 10, 30,and 60 mg/kg/day. In the renal medulla, the dopamine/norepinephrineratios were significantly (p<0.01) increased by 555%, 636% and 677%,respectively, at doses of 10, 30 and 60 mg/kg/day nepicastat, comparedto placebo. Dopamine levels were significantly (p<0.01) increased 522%at 30 mg/kg/day and marginally (0.05<p<0.10) increased by 150% and 156%,respectively, at 10 and 60 mg/kg/day. Norepinephrine levels weresignificantly (p<0.01) decreased 72% following administration of 10mg/kg/day nepicastat, compared to placebo, and marginally (0.05<p<0.10)decreased by 69% following 60 mg/kg/day.

Statistical analysis indicated that the concentration of nepicastat inplasma obtained on Day 4 and tissue and plasma obtained on Day 5 wasdose-proportional between each dose level and factored levels of itspartner dose. Therefore, dose points were determined to be linear, withthe following exceptions (a significant result would suggest the dataare not linear):

Kidney medulla: 3×10<30(p<0.05)

Kidney medulla: 6×10<60(p=0.077)

Plasma(day 4): 2×30>60(p=0.076)

On Day 5, levels of nepicastat in all tissues examined were higher thanthose in plasma.

The results demonstrated no difference between left ventricular samplesfrom the 10 mg/kg/day nepicastat treated group and vehicle treatedgroup.

Example 17

Nepicastat was evaluated for its activity at a range of enzymesincluding tyrosine hydroxylase, NO synthase, phosphodiesterase III,phospholipase A₂, neutral endopeptidase, Ca²⁺/calmodulin protein kinaseII, acetyl CoA synthetase, acyl CoA-cholesterol acyl transferase,HMG-CoA reductase, protein kinase (non-selective) and cyclooxygenase-I.As shown in FIG. 4, nepicastat had an IC₅₀ of >10 μM at all the 12enzymes studied, and therefore it is a highly selective (>1000-fold)inhibitor of dopamine-β-hydroxylase.

Example 18

Bovine DBH from adrenal glands was obtained from Sigma Chemicals (St.Louis, Mo.). Human secretory DBH was purified from the culture medium ofthe neuroblastoma cell line SK—N—SH and was used to obtain theinhibition data. A lentil lectin-sepharose column containing 25 ml gelwas prepared and equilibrated with 50 mM KH₂PO₄, pH 6.5, 0.5 M NaCl. Thecolumn was eluted with 35 ml of 10% methyl a, D-mannopyranoside in 50 mMKH₂PO₄, pH 6.5, 0.5 M NaCl at 0.5 ml/min. Fraction containing mostenzymatic activities were pooled and concentrated with an Amicon stirredcell using a YM30 membrane. Methyl a, D-mannopyranoside was removed bybuffer exchange with in 50 mM KH₂PO₄, pH 6.5, 0.1 M NaCl. Theconcentrated enzyme solution was aliquoted and stored at −25° C.

An HPLC assay was used to measure DBH activity using tyramine andascorbate as substrates. The method is based on the separation andquantitation of tyramine and octopamine by reverse phase HPLCchromatography (Feilchenfeld, N. B., Richter, H. & Waddell, W. H.(1982). Anal. Biochem: A time-resolved assay of dopamine β-hydroxylaseactivity utilizating high-pressure liquid chromatography. 122:124-128.). The assay was performed at pH 5.2 and 37° C. in 0.125 M NaAc,10 mM fumarate, 0.5˜2.0 M CuSO₄, 0.1 mg/ml catalase (6,500 u, BoeringerMannheim, Indianapolis, Ind.), 0.1 mM tyramine, and 4 mM ascorbate. In atypical assay, 0.5-1.0 milli-units of enzyme were added to the reactionmixture and then a substrate mixture containing catalase, tyramine andascorbate was added to initiate the reaction (final volume 200 μl).Samples were incubated at 37° C. for 30-40 minutes. The reactions werequenched by the stop solution containing 25 mM EDTA and 240 μM3-hydroxytyramine (internal standard). The samples (150 μl) were loadedto a Gilson autosampler and analyzed by HPLC using UV detection at 280nm. PC-1000 software (Thermo Separations products, Fremont, Calif.) wasused for integration and data analysis. The HPLC run was carried out atthe flow rate of 1 ml/min using a LiChroCART 125-4 RP-18 column andisocratic elution with 10 mM acidic acid, 10 mM 1-heptanesulfonic acid,12 mM tetrabutylammonium phosphate, and 10% methanol. The remainingpercent activity was calculated based on the control without inhibitor,corrected using internal standards and fitted to a nonlinear 4 parameterdose response curve to obtain the IC₅₀ values.

Purification of [¹⁴C]-Tyramine. [¹⁴C]Tyramine hydrochloride was purifiedby a C18 light load column (two columns combined into one) that waswashed with 2 ml of MeOH, 2 ml of 50 mM KH₂PO₄, pH 2.3, 30%acetonitrile, and then 4 ml of 50 mM KH₂PO₄, pH 2.3. A vacuum manifold(Speed Mate 30, from Applied Separations) was used to wash and elute thecolumn by vacuum. After loading of [¹⁴C]tyramine, the column was washedwith 6 ml of 50 mM KH₂PO₄, pH 2.3 and eluted with 2 ml of 50 mM KH₂PO₄containing 30% acetonitrile. The eluate was lyophilized to removeacetonitrile, resuspended in H₂O, and stored at −20° C.

Enzyme Assay by Radioactive Method. Enzymatic activity was assayed using[¹⁴C]tyramine as substrate and a C18 column to separate the product. Theassay was performed in 200 ml volume containing 100 mM NaAc, pH 5.2, 10mM fumaric acid, 0.5 M CuSO₄, 4 mM ascorbic acid, 0.1 mg/ml catalase andvarious concentrations of tyramine. The total counts of each reactionwas −150,000 cpm. Bovine DBH (0.18 ng for each reaction) was mixed withtyramine and inhibitor in the reaction buffer at 37° C. The reaction wasinitiated by the addition of ascorbate/catalase mixture and wasincubated at 37° C. for 30 minutes. The reaction was stopped by theaddition of 100 ml of 25 mM EDTA, 50 mM KH₂PO₄, pH 2.3. Entire mixturewas loaded to a C18 light load column (two combined into one) that waspre-washed with MeOH and equilibrated with 50 mM KH₂PO₄, pH 2.3. Elutioninto scintillation vials was carried out with 1 ml of KH₂PO₄, pH 2.3buffer twice, followed by 2 ml of the same buffer. ReadySafescintillation fluid (16 ml) was added to the scintillation vials and thesamples were counted for ¹⁴C radioactivity.

Nepicastat concentrations of 0, 1, 2, 4, 8 nM were used to studyinhibition kinetics at the following tyramine concentrations: 0.5, 1, 2,3, 4 mM. The ¹⁴C counts were identical in each reaction which wascarried out as described above. A blank control without the enzyme wasused to obtain the background. The data were corrected for background,converted to activity in nmol/min, and plotted (1/V vs 1/S). Km′ wascalculated from the slopes and Y intercepts and linear regression wasused to obtain Ki value.

The IC₅₀ values for SKF-102698, nepicastat and Compound B against humanand bovine DBH were obtained using the HPLC assay at the substrateconcentrations of 0.1 mM tyramine, 4 mM ascorbate at pH 5.2 and 37° C.All three compounds caused a dose-dependent inhibition of DBH activityon both bovine and human enzyme.

The IC₅₀ values calculated for nepicastat, Compound B and SKF-102698showed that the S enantiomer (nepicastat) was more potent than the Renantiomer (Compound B by 3-fold against bovine DBH and 2-fold) againstthe human enzyme. Nepicastat was more potent than SKF-102698 by 8-foldagainst bovine enzyme, and 9-fold against human DBH.

A Km of 0.6 mM was determined from the Lineweaver-Burk plot. Nepicastat(1-8 nM) caused a major shift in Km, as would be predicted for acompetitive inhibitor. The inhibition of bovine DBH by nepicastatappears to be competitive with tyramine. A Ki of 4.7±0.4 nM wascalculated by linear regression.

Nepicastat was a potent inhibitor of both human and bovine DBH. It was8-9-fold more potent than SKF-102698. nepicastat (the S enantiomer) is2-3 fold more potent than Compound B (the R enantiomer). The inhibitionof bovine DBH by nepicastat appeared to be competitive with tyramine,with a Ki of 4.7±0.4 nM.

Example 19

The affinity of nepicastat was determined in the bindings assaysoutlined using standard radioligand filtration binding methods wereused.

Competition binding data were analyzed by iterative curve fitting to afour parameter logistic equation. Hill coefficients and IC₅₀ wereobtained directly. pKi (−log of Ki) of competing ligands were calculatedfrom IC₅₀ values using the Cheng-Prusoff equation.

Nepicastat had moderate affinity for alpha₁ receptors (pKi of 6.9-6.7).The affinity at all other receptors examined was relatively low(pKi<6.2).

Example 20

At the time of dosing, a 60-mg/ml nepicastat formulation was prepared bymixing vehicle with nepicastat powder, followed by shaking. The 6- and20-mg/ml Nepicastat formulations were prepared by diluting the 60-mg/mlformulation with vehicle. The reconstituted nepicastat formulationsretained potency for the duration of use. The aqueous vehicle andnepicastat formulations contained hydroxypropylmethylcellulose, benzylalcohol, and polysorbate 80.

Dose selection was based on an acute toxicity study in which mice wereadministered single oral doses of 250, 1000, or 2500 mg/kg ofnepicastat. Clinical signs of toxicity and death occurred at 1000 and2500 mg/kg.

A single oral dose of vehicle or nepicastat formulation was administeredby gavage to each mouse using a rodent intubator. The oral route wasselected because it is a proposed clinical route of administration. Dosevolumes were calculated on the basis of individual body weights recordedbefore dosing (body weight data are not tabulated in this report). Foodand water were withheld from the mice 2.5 to 3.5 hours before dosing,instead of 1.5 hours as specified in the protocol. This deviation didnot affect the integrity of the study.

Clinical observations were recorded before dosing. Beginning 60 minutesafter dosing, mice in each treatment group were evaluated in groups ofup to 3 over an interval of approximately 10 minutes each for clinicalobservations and protocol-specified behavioral tests. One mouse in the30-mg/kg group and 1 mouse in the 100-mg/kg group died after dosing andthey were removed from the study. Surviving mice were euthanatized andremoved from the study at the end of the observation/testing period.

Mice in groups of 6 males each were administered single oral doses of 0(vehicle), 30, 100, or 300 mg/kg of nepicastat by gavage. Clinicalobservations and behavioral tests were initiated 60 minutes afteradministration of the test formulation. At the end of the observationperiod, all surviving mice were euthanatized and removed from the study.

Lower body temperatures were present in the 30-, 100-, and 300-mg/kggroups compared with the vehicle-control group. No treatment-relatedclinical or gross behavior changes were present. Rectal body temperaturedata are and observation and behavioral test data were obtained. Notreatment-related clinical or gross behavioral changes were present.Abnormal social grouping (listed as other reaction) occurred among micein the 100-mg/kg group, but not the 300-mg/kg group; this finding wasconsidered incidental. Clinical/behavioral changes in 1 mouse in the100-mg/kg group included inactivity, abnormal gait and posture,decreased induced activity, abnormal passivity, and soft/continuousvocalization; these changes were not attributed to nepicastat. One mouseeach in the 30- and 100-mg/kg group died after dosing; the deaths wereconsidered incidental and the mice were removed from the study.

Example 21

The purpose of this study was to determine if the DBH inhibitorsSKF-102698 and nepicastat produced changes in locomotor activity oracoustic startle reactivity. Changes in these behaviors may thereforereflect activity of these compounds in the central nervous system.

Adult male Sprague Dawley rats (250-350 g on study day) were obtainedfrom Charles Rivers Labs. Rats were housed under a normal light/darkcycle with lights on between 0900 Hrs. and 2100 Hrs. Animals were housedin pairs in standard metal wire cages, and food and water were allowedad libitum.

The locomotor activity boxes consisted of a PLEXIGLAS© box measuring18″×18″ by 12″ high. Surrounding the PLEXIGLAS© boxes were OmnitechDigiscan Monitors (model #RXXCM 16) which consisted of a one inch ban ofphotobeams and photosensors numbering 32 per box. The number ofphotobeam breaks were analyzed by an Omnitech Digiscan Analyzer (model#DCM-8). The animals were tested in an enclosed room with a white noisegenerator running to mask extraneous noise.

Acoustic startle reactivity tests were conducted in eight SR-Lab (SanDiego Instruments, San Diego, Calif.) automated test stations. The ratswere placed individually in a PLEXIGLAS© cylinder (10 cm diameter) whichis housed in a ventilated sound-attenuating enclosure. Acoustic noisebursts (a broad band noise with a rise time and fall time of 1 msec) waspresented via a speaker mounted 30 cm above the animal. A piezoelectricaccelerometer transforms the subject's movement into an arbitraryvoltage on a scale of 0 to 4095.

Prior to drug administration, each of seventy-two rats was placed in thestartle apparatus, and after a 5 minute adaption period they werepresented with an acoustic noise burst every 20 seconds for 15 minutes(45 startles total). The average startle was calculated for each rat bytaking the mean of startle number 11 through 45 (the first ten startleswill be disregarded). Sixty-four of these rats were then placed in oneof eight treatment groups such that each group had similar mean startlevalues. The eight treatment groups were as follows: SKF-102698 (100mg/kg) and its vehicle (50% water/50% polyethylene glycol), clonidine(40 μg/kg), nepicastat (3, 10, 30 and 100 mg/kg), and their vehicle,dH₂O. Previous work has shown that this matching procedure to be themost appropriate for startle since there is significant variability instartle response between rats, but a high degree of consistency withinrats from one day to the next.

Each day after this testing procedure, eight rats (one rat from each ofthe eight treatment groups) was injected with their assigned drugtreatment and immediately placed individually in a motor activity box.The rats motor activity was monitored for four hours. Next, the ratswere placed in a transfer cage for fifteen minutes. At the beginning ofthis fifteen minutes the rat that has been assigned the clonidinetreatment will receive another injection of 40 μg/kg. Next, the ratswere placed in the startle apparatus, and after a five minuteacclimation period they were presented with a 90 dB noise burst everyminute for four hours.

To evaluate motor activity, horizontal activity (number of photobeamsbroken), number of movements, and rest time were measured. Eachparameter was analyzed separately. At each time interval (or calledsample), a two-way analysis of variance (ANOVA) was performed using theranked data (nonparametric technique) to test for the treatment effectblocked by day. Pairwise comparisons for treated groups to the vehiclecontrol were also performed using Dunnett's t-test.

To evaluate startle reactivity, for the 200 milliseconds immediatelysucceeding each startle the average force exerted by each startled ratover the entire 200 milliseconds, and the maximum force, were measured.The mean maximum and average voltages (MAXMEAN and AVGMEAN) werecomputed for each treatment (TREAT) at each trial (TRIALN), and thenthese values were plotted against trial number for each treatment. Theplots are attached to the report. Trials 1-60 were set to time=1, trials61-120 to time=2, trials 121-180 to time=3 and trials 181-240 to time=4.The mean maximum and average startle responses was computed within eachtime and for each treatment. The means were then used in the statisticalanalysis. The startle responses were analyzed using analysis ofcovariance. Treatment comparisons within time were of interest to theinvestigators, but not time effects within treatments. Therefore, thestartle responses were analyzed by time. The model included terms forthe day the rat was tested (date), baseline startle response, andtreatment. Date was a blocking factor and baseline startle response wasa covariate. There were three separate models for each of the objectivesstated above. The varying doses of nepicastat were compared to vehicleusing Dunnett's procedure in order to control for multiple comparisons.

When the four nepicastat-treated groups were compared to thevehicle-treated controls, there were no overall no pairwise significantdifferences at any time examined in any of the 3 parameters.

When compared to the vehicle-treated controls, the clonidine-treatedgroup had significantly more horizontal activities at 2 and 2.5 hours,significantly more movements at 2 hours, and significantly less resttime at 2 hours (all p<0.05). Note that the clonidine-treated group hadsignificantly more rest time than the vehicle-treated controls at 1 hour(p<0.05).

When compared to the vehicle-treated controls, the SKF-102698-treatedgroup had significantly less horizontal activities and significantlyless movements at 2.5 hours (both p<0.05). Note that theSKF-102698-treated group had significantly more movements than thevehicle-treated controls at 1.5 and 4 hours (both p<0.05). Nosignificant differences between SKF-102698 and vehicle were detected atany time examined in the rest time.

In general, the horizontal activity and number of movements decreasedfor the first 2 hours and stayed low for the last 2 hours. Similarly,the rest time increased for the first 2 hours and remained elevated forthe last 2 hours.

Nepicastat had no significant effects on the locomotor activity in rats.Animals treated with 3, 10, 30 or 100 mg/kg of nepicastat were notsignificantly different from the vehicle-treated controls at any timeexamined in the horizontal activity, no. of movements or rest time.

In startle response, the overall treatment effects for nepicastat andvehicle were not significant (p>0.05) at any time for either response.The overall treatment effect for average startle response at time 2 wasmarginally significant (p=0.0703), and Dunnett's test revealed thatnepicastat 30 mg/kg had a significantly higher average startle responsethan the vehicle group (p<0.05). Baseline average startle response wasstatistically significant at times 3 and 4 for both responses (p<0.05),and marginally significant at times 1 and 2 for maximum startleresponse, and at time 2 for average startle response (p<0.10).

SKF-102698 (100 mg/kg) was not statistically significantly differentfrom vehicle at any time for either startle response measurement.

Clonidine had statistically significantly lower maximum and averagestartle responses than vehicle at time 1 (p<0.01) and at time 2 foraverage startle only (p=0.0352). The maximum startle response at time 2and the average startle response at time 3 for the clonidine group weremarginally significantly lower than the water group.

Nepicastat administered at 3, 10, 30, or 100 mg/kg does not appear toeffect the maximum or average startle response in rats at any time whencompared to vehicle. SKF-102698 behaved similarly to vehicle (PEG) forboth startle responses at all times. Clonidine successfully lowered bothmaximum and average startle response during earlier times, and behavedsimilarly to vehicle during later times.

Example 22

The effects of chronic dosing of nepicastat in rats were examined.Between three and thirteen days prior to the first dosing day the ratswere placed inside the startle apparatus and after a five minuteacclimation period they were presented with a 118 dB noise burst onaverage once a minute (a variable inter-trial interval ranging between30 and 90 seconds will be used) for 20 minutes. The startle responseswere measured and a mean for the last twenty startle response wascalculated for each rat. The rats were randomly placed in one of theeight treatment groups (nepicastat, 5, 15 or 50 mg/kg, bid; SKF-102698,50 mg/kg, bid; clonidine, 20 μg/kg, bid: d-amphetamine, 2 mg/kg, bid;dH₂O or cyclodextrin (SKF-102698's vehicle). Rats were dosed by oralgavage with a 10 ml/kg dosing volume. The rats were dosed in the morningand in the evening every day for ten day. The time in between morningand evening dosing will be between 6 and 10 hours. Previous work hasshown that this matching procedure to be the most appropriate foracoustic startle reactivity since there is significant variability instartle response between rats, but a high degree of consistency withinrats from one day to the next.

Since it was impossible to test all 96 rats (8 treatment groups, n=12)on the same day, the dosing schedule was staggered such that only 8 ratswere run every day. These 12 groups of eight rats each consisted of onerat from each of the eight treatment groups so that the treatment groupswere balanced across days. Furthermore, all treatment groups werebalanced across the eight motor activity chambers, however, treatmentgroups could not be balanced across the startle chambers.

The following behavioral tests were administered during and afterchronic dosing; body core temperature, motor activity, acoustic startlereactivity, and pre-pulse inhibition of acoustic startle.

The animals were tested in an enclosed room with a white noise generatorrunning. Motor activity tests were conducted immediately after the bodycore temperature reading taken on dosing day ten (about 3 hours and 35minutes after the morning daily dose of nepicastat, and SKF-102698, and20 minutes prior to the daily administration of clonidine andd-amphetamine on dosing day ten). Motor activity tests were run for onehour. A diagnostic program was run on each of the motor activitychambers prior to each test session to assure that the photo beams andlight sensors were operating properly. Motor activity has been shown tobe sensitive to changes in central dopamine levels (Dietze andKuschinsky, 1994) which makes this behavioral test a potential sensitiveassay to the effects of DBH inhibitors in-vivo. D-amphetamine was usedas the positive control for this assay.

Rat body core temperatures were obtained by inserting the rectal probe 2cm into the colon of each rat. Each rat's body core temperature wasmeasured three times and the average of the three reading wascalculated. Body core temperature readings were obtained immediatelyprior to the ten day chronic dosing schedule (to obtain a baseline), andthree and half hour after the morning daily dose of nepicastat, andSKF-102698, and 15 minutes prior to the daily administration ofclonidine and d-amphetamine, on dosing days one, five and ten. Body coretemperature has been shown to be sensitive to both dopamine andnorepinephrine levels, which makes this behavioral test a potentialsensitive assay to the effects of DBH inhibitors in-vivo. Both clonidine(an alpha₂ agonist), and d-amphetamine (a dopamine releaser) were usedas the positive controls for this assay.

Acoustic startle reactivity (a series of muscle contractions elicited byan intense burst of noise with a rapid onset), and pre-pulse inhibition(sensorimotor gating measured by analyzing any decrease in startlereactivity which occurs when a startling stimulus is immediatelypreceded by a non startling stimulus) were both measured in eight SR-Lab(San Diego Instruments, San Diego, Calif.) test stations. The rats wereplaced individually in a Plexiglas cylinder (10 cm diameter) which washoused in a ventilated sound-attenuating enclosure. Acoustic noisebursts (a broad band noise with a rise time and fall time of 1 msec)were presented via a speaker mounted 30 cm above the animal. Also, thesespeakers produced a 68 dB level of background noise throughout all testsessions. A piezoelectric accelerometer attached below the plexiglascylinder transduced the subject's movement into a voltage which was thenrectified and digitized (on a scale from 0 to 4095) by a PC computerequipped with SR-Lab software and interface assembly. A decibel meterwas used to calibrate the speakers in each of the eight test station to±1% of the mean. Additionally, a SR-Lab calibrating instrument was usedto calibrate each of the eight startle detection apparatuses to ±2% ofthe mean. Startle reactivity and pre-pulse inhibition tests were runconcurrently immediately alter the motor activity test (about 4 hoursand 40 minutes after the morning daily injection of nepicastat, andSKF-102698, and 10 minutes after a supplemental administration ofclonidine and d-amphetamine on dosing day ten). The startle reactivityand pre-pulse inhibition tests consisted of placing each ratindividually into a SR-Lab test station and after a five minuteacclimation period the rats were presented with one of three differenttypes of noise bursts (and startle reaction measured) on average once aminute (a variable inter-trial interval ranging between 30 and 90seconds was used) for an hour (60 total noise bursts and startlereactions). The three different types of noise bursts consisted of aloud noise burst (118 dB), and a relatively quite noise burst (77 dB),the quite burst preceding the loud noise bursts by 100 msec (pre-pulseinhibition trial). These trials were presented in pseudo-random order.Pre-pulse inhibition has been shown to be sensitive to changes inmesolimbic dopamine levels. Furthermore, acoustic startle reactivity hasalso been shown to be sensitive to changes in dopamine andnorepinephrine levels which makes these behavioral test a potentialsensitive assay to the effects of DBH inhibitors in vivo. Clonidine andd-amphetamine served as the positive control for the acoustic startlereactivity and pre-pulse inhibition of acoustic startle tests.

The schedule of daily behavioral tests was as follows. At t=0, DBHinhibitor is injected. At 3.5 hours, the core body temperature ismeasured. At 3 hr. 35 minutes, motor activity is assessed. At 4 hr. 40minutes, startle reactivity and pre-pulse inhibition are assessed.

Three temperature readings were taken from each subject per time oftesting. The avenge of these three readings was then calculated.

Each rats spontaneous locomotion was obtained by calculating the totalnumber of photobeams that the subject broke during the testing session.

The subject's reaction was measured during each trial for the 40 msecwindow after the stimulus was presented. Each startle reaction wascalculated by taking the avenge of 40 readings (one per millisecond)starting immediately after each noise burst. Acoustic startle reactivitywas calculated by determining the mean response for each subjectsstartle elicited by the 118 dB acoustic burst. Pre-pulse inhibitionvalues were calculated by subtracting the mean startle response elicitedby the 77 dB pulse-118 dB pulse paired trial (pre-pulse inhibition trialdescribed above) from the 118 dB alone trial and then dividing thisvalue by the 118 db alone trial for each rat, i.e. ([118 dB trialvalue-pre-pulse inhibition trial value]+118 db trial value).

An overall one-way ANOVA with a main effect for treatment was performedat each time on the change from baseline for each animal. Subsequentt-tests were performed for each comparison of interest.

Spontaneous motor activity was measured for each animal every 15 min for1 hour. Each time block (every 15 min) was analyzed separately.Kruskal-Wallis test (nonparametric technique) was performed to test forthe difference between treatment groups. If the overall significantdifference is not detected, Bonferroni's adjustment for multiplecomparisons is then made.

The mean average voltage (AVGMEAN) and mean percent prepulse inhibition(RATIO) were computed for each treatment (TREAT) and trial type (TRIALT)at each trial (TRIALN). Pre-pulse inhibition values were calculated bysubtracting the mean startle response elicited by the 77 dB pulse-118 dBpulse paired trial (pre-pulse inhibition trial described above) from the118 dB alone trial and then dividing this value by the 118 db alonetrial for each rat, i.e. ([118 dB trial value-pre-pulse inhibition trialvalue]+118 db trial value).

These values were plotted against trial number for each treatment andtrial type, and these plots are attached to the report. Note that they-axis on the plots varies. The trials 1-15 correspond to time 1, 16-30time 2, 31-45 time 3, and 46-60 time 4. Plots displaying the meanpercent prepulse inhibition and the mean average startle of animals overTIME for each treatment are attached also.

The average startle response and the percent prepulse inhibition wereanalyzed using Analysis of Variance. The model included terms fortreatment, animals nested within treatment, time and treatment by timeinteraction. Treatment effects were tested using the error term foranimals nested within treatment. Overall treatment effects and treatmenteffects by time were studied. The method of Fisher's Least SignificantDifferences was used to adjust for multiple comparisons. If the overalltreatment or treatment by time effects were not significant(p-value>0.05) then a Bonferroni adjustment was made. If the overalltreatment effects were nonsignificant, then the adjustment was appliedto the specific pairwise comparisons. Further, if the specific pairwisetreatment effect was not significant (p-value>0.05), then the adjustmentwas also applied to the treatment effects within time. If both theoverall treatment and treatment by time effects were not significant(p-value>0.05) then a Bonferroni adjustment was made for the individualcomparisons within time and averaging overtime.

The change from pre-dose in body weights was calculated for each animalfor the analysis. A repeated measures two-way ANOVA was used to test forthe overall effects of treatment, time and treatment by timeinteraction. One-way ANOVAS were then performed to test the treatmenteffect at each day.

The positive controls (d-amphetamine and clonidine) significantlyincreasing body core temperature on day one of the chronic dosing, butno other compound had any significant effect on body core temperature atany time.

The d-amphetamine group had significantly higher locomotor activity thanthe vehicle control at all times examined. The clonidine group, however,was not significantly different from the vehicle controls at any timeexamined. The SKF-102698 50 mg/kg b.i.d. group had significantly lowerlocomotor activity than its vehicle control at the first 45 minutes(i.e. samples 1-3), but not significant after 45 minutes.

There was no overall significant treatment effect for nepicastat at anytime examined. Pairwise comparisons revealed that none of thenepicastat-treated groups were significantly different from the vehiclecontrols at any time examined. Also, there was no significant differencebetween the two vehicle controls (dH₂O and SKF's vehicle) at any timeexamined.

None of the treatment groups produced any significant change inpre-pulse inhibition. The overall time effect was statisticallysignificant for the SKF-102698 group and the cyclodextrin group(p=0.0001). The treatment by time interaction was statisticallysignificant for cyclodextrin versus dH₂O (p=0.0283), but no others.Treatment effects were not significant for any comparisons of interest.However, the SKF group had marginally higher percent prepulse inhibitioncompared to the cyclodextrin group (p=0.0782).

During times 1 and 2, the clonidine group had just significantly higherpercent prepulse inhibition than the vehicle control and were notsignificantly different from vehicle during times 3 and 4. Neitherd-amphetamine nor SKF-102698 was significantly different from their ownvehicle at any time. None of the nepicastat dose groups weresignificantly different from dH₂O at any time.

Only the SKF-102698 treatment group produced a significant change inacoustic startle reactivity. The overall time effect was statisticallysignificant for all comparisons of interest (all p=0.0001). Thetreatment by time interaction was statistically significant for thecomparisons of amphetamine versus dH₂O, clonidine versus dH₂O andcyclodextrin versus dH₂O (all p<0.05), but no others. Treatment effectswere significant for SKF-102698 50 mg/kg b.i.d. versus cyclodextrin(p=0.0007) and for nepicastat 50 mg/kg b.i.d. versus SKF-102698 50 mg/kgb.i.d. (p=0.0047), but no others. The SKF-102698 50 mg/kg b.i.d. grouphad significantly lower startle response compared to cyclodextrin, andalso had significantly lower startle response as compared to thenepicastat 50 mg/kg b.i.d. group.

The SKF-102698 (50 mg/kg b.i.d.) group had significantly lower startleresponse than the cyclodextrin group at all times. During times 1 and 3,the nepicastat (50 mg/kg b.i.d.) group had significantly higher startleresponse than the SKF-102698(50 mg/kg b.i.d.) group. No othersignificant differences were detected.

There was no overall or pairwise significant differences in body weightbetween groups at the pre-dose baseline.

The d-amphetamine group had a significantly smaller change in bodyweight from pre-dose than the vehicle controls (p<0.01). When analyzedwithin each day, the vehicle controls had a significantly greaterincrease from pre-dose in body weight than the amphetamine group attreatment days 4-10. The clonidine group, however, was not significantlydifferent from the vehicle controls at any time examined. The SKF-102698(50 mg/kg b.i.d.) group showed a significantly smaller increase (p<0.01)in body weight from pre-dose baseline than its vehicle control(SKF-vehicle). When analyzed within each day, the SKF-vehicle controlshad a significantly greater increase from pre-dose in body weight thanthe SKF-102698 group at treatment days 2-10, except days 3 and 6.Importantly, there was no difference in changes in body weight betweenthe SKF-vehicle and the vehicle control groups on any day.

There was no overall significant treatment effect on body weight for anydose of nepicastat at any time examined. Pairwise comparisons revealedthat none of the nepicastat-treated groups were significantly differentfrom the vehicle controls at any time examined. Interestingly, there wasa significant (p<0.05) overall difference between the SKF-102698 (50mg/kg b.i.d.) group and the nepicastat (50 mg/kg b.i.d.) group withrespect to changes in body weight. When analyzed within each day, theSKF-102698 (50 mg/kg b.i.d.) group had significantly lower body weightsthan the nepicastat (50 mg/kg b.i.d.) group at days 7-9.

Example 23

1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) was purchased fromRBI, Inc, (Natick, Mass.). For administration, MPTP was suspended inwater at a concentration of 2 mg/mI (free base) and was injectedsubcutaneously in a volume (ml) equal to the weight (kg) of each animal.For example, a 950 gram animal received an injection of 0.95 ml of MPTPat 2 mg/mI resulting in 2.0 mg/kg final per injection.

Monkeys were maintained on a 13 h/11 h light-dark cycle, with food andwater available ad libitum. All procedures used in this study followedNIH guidelines and were approved by the Institutional Animal Care andUse Committee (IACUC). Animals were individually housed and allowed aminimum of one month to acclimate to the colony prior to commencingbehavioral studies.

Six squirrel monkeys, three non-lesioned and three lesioned (received 2mg/kg MPTP 3 months prior), were used to study the optimal route ofadministration of nepicastat. Three different approaches were examinedincluding (i) insertion into treats, (ii) oral syringe, and (ii) oralgavage. Insertion of nepicastat solution (5 mg/ml) into marshmallows wastested in 3 non-lesioned monkeys and proved to be a poor route of drugadministration due to failure of animals to ingest treats probably dueto adverse taste. Oral syringe injection of nepicastat (0.5, 2, and 5mg/kg) into the mouth of three non-lesioned and three lesioned monkeyswas also not an acceptable route since animals tended to spit out thesolution at the highest drug concentration. Oral gavage administrationwas carried out in 3 MPTP-lesioned monkeys at the highest dose (5 mg/kg)and was well accepted.

Six squirrel monkeys, three non-lesioned and three lesioned (received 2mg/kg MPTP 3 months prior), were used to study safety and tolerabilityof nepicastat. Animals received nepicastat at a concentration of 0.5,2.0, or 5.0 mg/kg twice daily, (10 am and 2 μm), for 5 days with atwo-day washout between the different dose levels. Nepicastat wasadministered via oral syringe at the 0.5, 2.0 and 5.0 mg/kg doses and asoral gavage at the 5.0 mg/kg dose. Drug was well tolerated at the twolower doses. One non-lesioned monkey receiving 5.0 mg/kg had light beigecolored loose stools on the final two days of administration thatresolved upon one day withdrawal of drug.

Twenty four squirrel monkeys, fourteen females and ten males were usedin a Parkinsonian model. The twenty-four animals were randomly assignedto one of four treatment groups, with 6 animals per group. The groupsconsisted of the following: Group A (6 animals) received placebo (water)treatment; Group B (5 animals) received drug nepicastat at 1 mg/kg/day(0.5 mg/kg twice daily); Group C (6 animals) received 4 mg/kg/day (2mg/kg twice daily); and Group D (6 animals) received 10 mg/kg/day (5mg/kg twice daily). In Group B, one animal died acutely followingMPTP-lesioning, and was not replaced.

Prior to lesioning, animals were subjected to quantitative assessment ofspontaneous motor activity using an infrared activity monitor (IRAM)cage. All recording sessions were 60 minutes in length and were carriedout for 10 sessions over a period of 2 weeks. The behavior of animalswas also assessed by 1 to 3 clinical raters using a parkinsonianclinical rating scale (CRS) once per day (12 noon to 1 pm) for 3 to 5consecutive days. Normal animals did not typically score greater than 3on the CRS. Both the activity monitoring (IRAM) and clinical ratingassessments established the mean base-line activity of each animal.

Animals were lesioned by the administration of MPTP at a concentrationof 2.0 mg/kg (free-base) via subcutaneous injection to achieve aparkinsonian state. A post-MPTP lesioning behavioral assessment wascarried out 2 to 4 weeks after the last MPTP-lesioning. Locomotoractivity was monitored by IRAM in 60-minute sessions for 3 to 5 days.Clinical behavior (CAS) was assessed by one to three individuals ratingover a period of 3 to 5 days.

In some cases, animals required additional doses of MPTP (2 mg/kg) toobtain a sufficient degree of lesioning to display parkinsoniansymptoms, defined as an average total clinical rating score greater than3. All animals received a final post-MPTP behavioral assessment (IRAMand CRS), within three weeks of starting the efficacy study. This finalpost-MPTP evaluation was used to establish a baseline clinicalparkinsonian state and used as a pretreatment value for statisticalanalysis.

Animals were tested for response to L-Dopa and the efficacy of drugnepicastat. Testing was carried out 4 to 12 weeks after the last MPTPdose. L-Dopa was administered at a concentration of either 2.5, 5, or7.5 mg/kg by oral gavage twice daily (at 10 am and 2 pm) for 7consecutive days. Behavior was determined by IRAM and CRS. Clinicalrating was carried out 60 to 90 minutes following the 10 am morning doseon the last 4 days of treatment. Raters (one to three individuals) wereblinded to the different treatment groups. IRAM assessment werepreformed for 90 minutes immediately following drug administration at 2pm on the last 2 to 5 days of drug treatment. There was a minimum 2 daywashout period between each treatment dose.

Nepicastat or water (as placebo) was administered for 12 days followinga minimum 2 day washout after L-Dopa dosing. Drug was administered twicedaily at 10 am and 2 pm by oral gavage. Behavior was rated by IRAM andCRS. The CRS was conducted in the morning, 60 to 90 minutes after the 10am dose of nepicastat on the last 5 days of drug treatment. Raters (oneto three individuals) were blinded to the different treatment groups.IRAM assessments were preformed for 90 minutes immediately followingdrug administration at 2 pm on the last 5 days of drug treatment.

For statistical analysis, locomotor activity and clinical rating scoreswere monitored. The average locomotor activity was calculated pre- andpost-MPTP-lesioning for each animal. The pre-MPTP-lesioning baseline wasdetermined by averaging ten 1-hour monitoring sessions. The post-MPTP(pre-treatment) behavioral assessment was obtained within three weeks ofcommencing the efficacy study. The post-MPTP-lesioning locomotoractivity was determined by averaging three to five 1-hour monitoringsessions (IRAMS). Activity monitoring was reported as “movements/10minutes”. A higher score was considered a faster animal. The Wilcoxonsign rank test was used to compare pre- and post-MPTP-lesioning activityfor each group of animals (groups A through D).

IRAM Locomotor activity was monitored every 10 minutes for a minimum of90 minutes following each drug level. A higher rating is considered afaster (less parkinsonian) animal.

Statistical analysis consisted of descriptive statistics and graphingthe mean of each 10 minutes data blocks of placebo and experimental drugat 1, 4, and 10 mg/kg. The graph was then examined to detect any trends.Further statistical analysis was not performed since no difference wasdetermined from graphical analysis.

Statistical analysis comparing post-MPTP lesioning (pre-treatment) to2.5, 5.0, and 7.5 mg/kg L-Dopa and nepicastat (1, 4, 10 mg/kg/day orplacebo) was not performed due to insufficient IRAM data collection.Only 60 minutes sessions were collected at Post-MPTP, versus 90 minutesfor nepicastat.

In the clinical rating score measurements, no pre-MPTP-lesioned animalscored greater than three on the CRS. A post-MPTP clinical rating scorewas determined within three weeks of commencing the efficacy study byaveraging the total CRS of 1 to 3 individual raters from data over 3 to5 consecutive days.

Eight parkinsonian features were rated in each animal and the totalscore was derived from the sum of these eight features. For each animal,a single clinical rating score was obtained for each drug dose byaveraging the clinical rating scores of all raters (one to three)conducted over the consecutive multiple dosing (with the same dose)days. This average CRS was used for statistical analysis. A lower scorewas considered a less parkinsonian behavioral state.

Statistical analysis consisted of: (1) comparisons between the averageCRS of placebo to nepicastat at 1, 4, and 10 mg/kg/day using theKruskal-Wallis (non-parametric analysis of variance). This comparisonwas repeated using the average CRS for each experimental drugconcentration corrected by the final post-MPTP ratings for each animal.The corrected clinical scores are clinical scores of experimental drugat each concentration as a ratio of post-MPTP clinical scores. (2)Pairwise comparisons between the average CRS post-MPTP lesioning(pre-treatment) to 2.5, 5.0, and 7.5 mg/kg L-Dopa and placebo treatmentusing Friedman's analysis (non-parametric analysis of variance, repeatedmeasures). The same analysis was performed for nepicastat atconcentrations of 1, 4, and 10 mg/kg. Dunnett's post hoc analysis fornon-parametric data was performed when needed.

IRAM (activity monitoring) and CRS (clinical rating scale) were used toassess the degree of MPTP-lesioning in each squirrel monkey.

There was no significant difference between pre-lesioned andpost-lesioned IRAM groups due to the high degree of variability ofmovements per 10 minutes per animal for Group A: Placebo Treatment.Wilcoxon signed rank test: W=19, N=6, P<0.06 Accept Null Hypothesis. Theaverage CRS for group A was 8.9, range 4.8 to 15.4. All animals showedsubstantial increase in the clinical rating scores after MPTP-lesioning.Normal animals (non-lesioned) typically have scores less than 3.

There was no significant difference between pre-lesioned andpost-lesioned IRAM groups due to the high degree of variability ofmovements per 10 minutes per animal for Group B: 1 mg/kg/day Treatment.Wilcoxon signed rank test: W=9, N=5, p<0.06 Accept Null HypothesisClinical Rating Score (CRS). The average CRS for group B was 10.32,range 4.3 to 16.1. All animals showed substantial increase in theclinical rating scores after MPTP-lesioning. Normal animals(non-lesioned) typically have scores less than 3.

There was no significant difference between pre-lesioned andpost-lesioned IRAM groups due to the high degree of variability ofmovements per 10 minutes per animal for Group C: 4 mg/kg/day Treatment.Wilcoxon signed rank test: W=17, N=6, P>0.06 Accept Null Hypothesis Theaverage CRS for group C was 8.97, range 6.5 to 17.3. All animals showedsubstantial increase in the clinical rating scores after MPTP-lesioning.Normal animals (non-lesioned) typically have scores less than 3.

There was no significant difference between pre-lesioned andpost-lesioned IRAM groups due to the high degree of variability ofmovements per 10 minutes per animal for Group D: 10 mg/kg/day treatment.Wilcoxon signed rank test: W=21, N=6, P>0.06 Accept Null Hypothesis. Allanimals showed substantial increase in the clinical rating scores afterMPTP-lesioning. The average CRS for group C was 8.02, range 4.0 to 15.6.Normal animals (non-lesioned) typically have scores less than 3.

Overall there was no significant difference in the locomotor activity asmeasured by IRAM between base-line (pre-MPTP-lesioning) andpost-MPTP-lesioning within groups due to the high degree of variabilityof the RAM results for each animal. The CRS results showed a differencebetween pre-MPTP and post-MPTP-lesioning states. Pre-MPTP-lesionedanimals scored no greater than 3 in the CRS. Post-MPTP-lesioned animalsall scored greater than 3. All groups (A through D) had an average CRSranging from 8 to 10 out of a total possible CRS score of 24.

There were no detectable differences between placebo treatment and threedifferent concentrations of nepicastat (1, 4, 10 mg/kg/day) in theMPTP-lesioned squirrel monkey. Both 4 and 10 mg/kg/day of nepicastat andplacebo showed a significant improvement over the post-MPTP(pre-treatment) state. All groups of animals showed significantimprovement with both 5 mg/kg and 7.6 mg/kg L-Dopa when compared topost-MPTP (pre-treatment), with the exception of Group C for the 7.5mg/kg dose and Group B for the 5 mg/kg/dose. No groups of animalsdemonstrated significant improvement at 2.5 mg/kg L-Dopa when comparedto post-MPTP.

A comparison of treatment groups and L-DOPA, Friedman test results,descriptive statistics, and Dunnett's test post hoc analysis was done,and a comparison between the activity monitoring of placebo treatment toall other concentrations of nepicastat at time points 10 to 90 minutespost-dosing. Ten-minute intervals were plotted for each drug dose level.There was no difference of drug (nepicastat) treatment at the 4 and 10mg/kg/day dose level when compared to placebo. At 1 mg/kg/day animalswere slower than placebo treatment. Based on a non-pairwise comparativeanalysis of 4 different treatment groups (1,4, and 10 mg/kg ofnepicastat and placebo), nepicastat produced no significant effect inparkinsonian symptoms compared to placebo (water treatment) in theMPTP-lesioned non-human primate model of PD. Based on a pairwisecomparative analysis of animals, (animals of the same group examined preand post treatment), nepicastat at 4 and 10 mg/kg/day concentrationsshowed a significant effect in parkinsonian symptoms compared topost-MPTP lesioning, (pre-treatment evaluation). Placebo had aborderline significant effect. Using the same pairwise comparison, 5 and7.5 mg/kg of L-Dopa demonstrated a significant effect when compared tothe post-MPTP lesioned state in all groups with the exception of Group B(no effect at 5 mg/kg L-Dopa) and Group C (no effect at 7.5 mg/kgL-Dopa) animals. However, 2.5 mg/kg of L-Dopa demonstrated nosignificant effect.

A pharmacokinetic study was carried out to determine the plasmaconcentration of nepicastat in the squirrel monkey. This study wascarried out concurrently with the safety and tolerability study. ThreeMPTP-lesioned squirrel monkeys (#353, 358 and 374) were used. Onemilliliter of blood (drawn from the femoral vein of each animal) wascollected for analysis. Nepicastat was administered at concentrations of1, 4, and 10 mg/kg for 5 days with a 2-day washout between each drugconcentration. Blood was collected for analysis 1 hour prior to thefirst dose to establish baseline and at 6 hours after this first drugdose of each of the different drug levels.

A second pharmacokinetic study was carried out to determine thesteady-state plasma level of nepicastat. This study was carried outconcomitantly with the efficacy study where animals were tested on eachof three different drug concentrations for 12 days. One milliliter ofblood was drawn from the femoral vein 6 hours after the first dose onday 1, then 6 hours after the first dose on day 7, and finally 6 hoursafter the first dose on day 12. Baseline plasma levels were determinedon samples collected the week prior to drug dosing.

This study also demonstrated that, a pairwise analysis, which reducesanimal to animal variability by comparing the same animal pre- andpost-treatment, is better suited for detecting a significant drug effectthan a non-pairwise study design when a small number of animals is used.

Example 24

Male, spontaneous hypertensive rats (280-345 g; Charles River Labs,Kingston, N.Y.) were fasted overnight then anesthetized with ether. Afemoral artery and femoral vein were cannulated with PE50 tubing forrecording of blood pressure and administration of compounds,respectively. Animals were then placed in MAYO restrainers and theirfeet loosely taped to the restrainer. Heparinized saline (50 unitssodium heparin/ml) was used to maintain patency of each cannulathroughout the experiment. The following parameters were continuouslyrecorded using Modular Instruments MI² BIOREPORT™ software installed onan IBM personal computer: mean arterial pressure (MAP), heart rate (HR),and the change from baseline for each parameter at specified time pointsin the experiment.

All compounds were dissolved on the day of use. Nepicastat was dissolvedin deionized water (vehicle) to a free base concentration of 1 mg/ml.Oral dosing volume for nepicastat or vehicle was 10 ml/kg. SCH-23390 wasdissolved in saline (vehicle) to a free base concentration of 0.2 mg/ml.Nepicastat or saline were administered intravenously as a bolus in avolume of 1.0 ml/kg followed by 0.2 ml flush of isotonic saline.

Following surgical preparation, each animal was allowed a minimum onehour recovery period. Animals were randomly assigned to four treatmentgroups: vehicle (iv)/vehicle (po); vehicle (iv)/nepicastat (po);SCH-23390 (iv)/vehicle (po); or SCH-23390 (iv)/nepicastat (po). Onceanimals were stabilized (minimum one hour), baseline blood pressure andheart rate was determined by taking an average of each parameter over a15 min period of time. Once baseline blood pressure and heart rate wereestablished, animals were dosed intravenously with either SCH-23390 (200μg/kg) or vehicle (saline, 1 ml/kg). Fifteen minutes later, animals wereorally dosed with either nepicastat (10 mg/kg) or vehicle (deionizedwater, 10 ml/kg).

Recorded parameters were measured 15 min prior to intravenous dosing toestablish baseline blood pressure and heart rate. Recorded parameterswere then measured at 5, 10, and 15 min following intravenousadministration of SCH-23390 or vehicle. Following oral administration ofnepicastat or vehicle, recorded parameters were measured at 15, 30, 60,90, 120, 150, 180, 210, and 240 min.

At the end of the experiment, each animal was anesthetized withhalothane and euthanized via decapitation. The cortex, left ventricle(apex), and mesenteric artery were dissected out, weighed, and fixed in0.4 M perchloric acid. Tissues were then frozen in liquid nitrogen andstored at −70° C. Biochemical analysis are performed on these tissues ata later date to determine catecholamine levels including dopamine andnorepinephrine levels. Blood pressure and heart rate were analyzedseparately. The change from baseline for blood pressure and heart ratewere analyzed by an analysis of variance (ANOVA) with effects fortreatment, time, and their interaction. This analysis was performed bothfor the post-iv time period and for the post-oral time period. Furtheranalyses were performed at each time by an ANOVA with a main effect fortime. Pairwise comparisons were performed following each ANOVA byFisher's LSD strategy with a Bonferroni correction when the overalltreatment effect was not significant.

An additional analysis was performed to compare the baseline means ofeach treatment group by an ANOVA with a main effect for treatment andsubsequent pairwise comparisons. Comparisons of SCH-23390 (iv)/Vehicle(po) vs. Vehicle (iv)/Vehicle (po), Vehicle (iv)/nepicastat (po) vs.Vehicle (iv)/Vehicle (po), and SCH-23390 (iv)/nepicastat(po) vs. Vehicle(iv)/nepicastat (po) were made.

There were no significant differences in baseline heart rate or meanarterial pressure between treatment groups.

Intravenous treatment with SCH-23390 resulted in a significant decrease(p<0.05) in heart rate during the post-oral period at 120 min and 240min compared to vehicle control. Nepicastat did not decrease the heartrate as much as observed in vehicle treated animals. This wasstatistically significant (p<0.05) at 150 and 180 min post dose. Thelarge variability in heart rate observed over the course of thisexperiment should be noted.

Intravenous administration of SCH-23390 produced a small (5±1 mmHg) yetsignificant decrease (p<0.05) in mean arterial pressure compared toanimals that received vehicle during the 15 min post-iv period. Oraltreatment with nepicastat caused a significant decrease (p<0.05) in meanarterial pressure by 30 min post dose which continued for the durationof the experiment. Pretreatment with SCH-23390 did not significantlyattenuate the antihypertensive effects observed with nepicastatadministration alone.

Example 25

Male Crl:COBS(WI)BR rats of 15 weeks old were used. Twenty-four ratswere chronically implanted with telemetry implants (TA11PA-C40, DataSciences, Inc., St. Paul, Minn.) for measurement of arterial bloodpressure, heart rate and motor activity. The rat was anesthetized withpentobarbital sodium (60 mg/kg, ip) and its abdomen shaved. Underaseptic conditions, an incision was made on midline. The abdominal aortawas exposed, and cannulated with the catheter of a telemetry transmitterunit. After the transmitter was sutured to the abdominal musculature,the skin was closed. Each rat was allowed to recover for at least 2weeks before being subjected to drug administration. Three days prior tothe start of the experiment, the rats were randomly divided into 4treatment groups: Vehicle (p.o.), Hydralazine (10 mg/kg, p.o.),nepicastat (30 mg/kg, p.o.), nepicastat (100 mg/kg, p.o.).

Systolic blood pressure (SBP), diastolic blood pressure (DBP), meanblood pressure (MBP), heart rate (HR), and motor activity (MA) weremonitored. Both nepicastat and hydralazine were prepared in water withtraces of Tween 80. All doses were given orally to the rat in 10 ml/kgand were expressed as free base equivalents.

A computerized data collection system was used to continuously collectdata on SBP, DBP, MBP, HR, and MA. Data on each rat were collected every5 min. for 10 sec. These were then averaged hourly and standard errorsof the mean (SEM) calculated. All values were expressed as means SEM.Statistical significance was defined as a p level of less than 0.05.Data on MBP, HR and MA were analyzed separately. Each analysis was doneon 26 time points measured each day. A two-way ANOVA with main effectsfor treatment and time and their interaction was used. If an overalltreatment effect or a significant interaction was detected, a series ofone-way ANOVA at each time point would be performed. The pairwisecomparisons at each time point were performed using Dunn's procedure. Ifno overall treatment effect was detected, then the pairwise differencefrom control would be performed by adjusting the critical value using aBonferroni adjustment.

After the pre-dose values for these parameters were established,respective groups of rats received a 7 day daily treatment of vehicle,nepicastat or hydralazine.

Oral administration of nepicastat at 30 mg/kg (all doses expressedhereafter are po) tended to slowly lower blood pressure but did notinduce a consistent hypotensive effect on day 1. As the effectprogressed, a peak hypotensive effect of −10 mmHg was observed on day 2at hour 13. Similar degrees of antihypertensive effects were inducedthroughout the study. At 100 mg/kg, the compound induced a peakantihypertensive response of −11 mmHg 22 hr after dosing on day 1(p<0.01). MBP continued to decrease and reached its nadir ofapproximately −17 mmHg on day 3 (p<0.01). The MBP remained lowthroughout the study.

Hydralazine at 10 mg/kg caused an immediate hypotensive effect whichsubsided in 10 hr, and a maximal decrease of −24 mmHg (p<0.01) in MBPwas observed within 1 hr after dosing on day 1. Similar transienthypotensive effects were observed throughout the study.

Nepicastat at 30 and 100 mg/kg, did not consistently affect HR on day 1.On day 2, however, Nepicastat at 100 mg/kg caused a bradycardic responseof −100 b/mm 3 hours after dosing. Significant but less pronouncedbradycardic responses were observed on days 3-7. In comparison,hydralazine at 10 mg/kg induced varying degrees of tachycardiathroughout the study.

Throughout the study, none of the drug treatments showed a consistenteffect on MA.

Body weights were recorded daily. For body weight, a two-way ANOVA withrespect to the changes from pre-dose was used to analyze overall effectsfor treatment, day, and treatment by day interaction. Then a one-wayANOVA was performed for each day, and pairwise comparisons for thedrug-treated groups to the vehicle controls were made using Dunn'sprocedure and Fisher's LSD strategy to adjust for multiple comparisons.Compared to that treated with vehicle, none of the drug treatments hadany effect on body weights (p<0.05). Although treatment with nepicastatat 100 mg/kg tended to decrease body weight on day 3, it was notstatistically significant.

Example 26

Nepicastat reduces the conversion of dopamine to norepinephrine. Basictests for nepicastat activity measure the levels of plasma or urinarydopamine or the ratio of dopamine to norepinephrine. Nepicastattreatment can increase plasma or urinary levels of dopamine or increasethe dopamine/norepinephrine ratio in plasma or urine.

Shown in FIG. 5, are the levels in urinary dopamine levels in normalvolunteers after 24 hour treatment with nepicastat.

Using the repeated-measures analysis of variance model, a significantincrease in the mean supine plasma dopamine/norepinephrine ration wasdetected in subjects receiving 200 mg of nepicastat when compared tothose receiving placebo (p<0.05). Urinary dopamine levels increasedafter 10 days of dosing with both 40 mg and 200 mg of nepicastat.

Example 27

In patients with chronic heart failure (CHF), daily doses of 40, 80, and120 mg of nepicastat administered for 10 days were generally welltolerated. The dose at which the frequency of significant adverse eventsincreased was 160 mg.

Four of 8 patients treated with 160 mg for 8 days or longer developed arash. Two of the rashes were accompanied by pruritus. One patient alsohad shortness of breath with the rash.

One patient treated with the 80 mg dose was withdrawn from the studybecause of symptomatic orthostatic hypotension. Concomitant medicationsincluded hydralazine and three diuretics. Occasional cases oforthostatic hypotension were reported in patients on all doses,including placebo. Symptomatic orthostatic hypotension was reported in 6of the 8 patients who received 160 mg

In an ongoing study in patients with CHF, there have been 2 deaths: onedeath was due to worsening CIF (patient was receiving 80 mg qd) and onewas sudden death in a patient who was receiving placebo.

One serious adverse event reported as possibly being related to drug wasan increasing creatinine level, which required hospitalization.Medically significant events not considered related to study druginclude: worsening CIF in 2 patients (one of whom subsequently had anacute MI and cardiac arrest), unstable angina in 1 patient, atypicalchest pain in 1 patient, and an adrenal mass in 1 patient who had ahistory of breast cancer.

In studies of congestive heart failure patients, changes in plasmadopamine levels, norepinephrine levels, and dopamine/norepinephrineratios after treatment with nepicastat in a 10 day study weredetermined. Nepicastat treatment increased dopamine/norepinephrinelevels in the 10 day study.

In studies of congestive heart failure patients, plasma dopamine levels,norepinephrine levels, and dopamine/norepinephrine ratios and changes ofthe levels and the ratios after treatment with nepicastat in a 30 daystudy were determined. As Nepicastat treatment increaseddopamine/norepinephrine levels in the 30 day study.

Example 28

Dopamine/norepinephrine ratios in the brain of rodents treated withnepicastat were determined. Dopamine/norepinephrine ratios increased inthe brains of rodents treated with nepicastat or disulfiram.

It will be readily apparent to one of ordinary skill in the relevantarts that other suitable modifications and adaptations to the methodsand applications described herein are suitable and may be made withoutdeparting from the scope of the invention or any embodiments thereof.While the invention has been described in connection with certainembodiments, it is intended to cover such alternatives, modifications,and equivalents as may be included within the spirit and scope of theinvention as defined by the following claims.

Example 29

The delayed-matching-to-position (DMTP) test is used to examine thepotential effects of drugs on short-term or working memory in rats.

Prior to the commencement of testing nepicastat in the delayed matchingto position study, pilot studies were performed with the aims ofassessing the behavioural/physiological effects of both acute andrepeated administration of the highest proposed dose of nepicastat (100mg/kg p.o.) and establishing the maximum tolerated oral dose ofphysostigmine administered repeatedly.

In pilot studies, nepicastat (30 and 100 mg/kg p.o.) or vehicle wasadministered acutely to male Sprague-Dawley rats (n=8) within the sameweight range as the trained animals (400-480 g). The animals wereobserved by an observer blind to the treatment status of each animal at1, 3 and 24 h following drug or vehicle administration. Similarly, in aseparate study, physostigmine (1, 3, 10 or 30 mg/kg p.o.) or vehiclewere administered acutely to groups of 8 rats. Observations were made at1, 3 and 24 hr after drug or vehicle administration.

In pilot studies of repeated administration, nepicastat (100 mg/kg p.o.)or vehicle was administered twice daily (06:00 and 18:00 h) for 10 days(once on day 11) to groups of 8 rats. The weights of the animals weremonitored throughout the study and, on day 5, the animals were observed‘blind’ by an independent observer in order to assess any overtbehavioural/physiological effects following repeated administration. Ina separate study, groups of 8 rats received vehicle or physostigmine(0.3, 1, 3 or 10 mg/kg p.o.) using the same dosing schedule. The weightsof the animals were monitored throughout the study.

Nepicastat (30 or 100 mg/kg p.o. acutely) did not induce any overtbehavioural/physiological changes. Similarly, there were no overteffects of repeated administration of nepicastat at a dose of 100 mg/kgp.o. However, in the latter study the drug-treated animals displayed amean loss in body weight of 28 g after 11 days whereas controls had amean increase in body weight of 1 g. Drug treated animals also becamemore irritable than controls when handled during the 11 day study.

Acute administration of physostigmine at doses of 3 mg/kg or higherinduced overt behavioural effects (chewing mouth movements andsalivation). Signs of toxicity were observed at 30 mg/kg p.o. (cyanosis,tremor, head jerks, ataxia). Repeated administration of 3 and 10 mg/kgp.o. physostigmine was toxic (3 of 8 animals were found dead on day 2 inthe 10 mg/kg group, and 2 of 8 animals convulsed on day 5 in the 3 mg/kggroup). There were no effects of repeated administration of 0.3 or 1mg/kg physostigmine.

As a result of these studies the highest dose of nepicastat for the DMTPstudy was reduced to 30 mg/kg p.o. and a dose of 1 mg/kg p.o. ofphysostigmine was chosen for repeated administration.

In the present DMTP study, rats were trained to remember the position ofa lever across a scheduled delay of either 0, 8, 16 or 32 s in order toearn food reward. Following training, the effects of repeatedadministration of nepicastat (1, 3, 10 and 30 mg/kg p.o. b.i.d.) orphysostigmine (1.0 mg/kg p.o., b.i.d.) were examined across 10successive days of testing in the DMTP task. On the eleventh day of theexperiment, the animals that were treated with nepicastat andphysostigmine were co-administered scopolamine Hbr (0.1 mg/kg, s.c., 30mm pretreatment time). The dose of scopolamine was selected on the basisof data from a pilot DMTP study in which 0.1 mg/kg of scopolamine wasfound to induce a significant impairment in choice accuracy. In additionto the animals treated with either nepicastat or physostigmine, onegroup of animals which had previously been treated with vehicle, wastreated with scopolamine. Another group of rats received only vehicletreatment throughout the experiment. The purpose of the finalscopolamine test was to determine whether chronic administration ofnepicastat or physostigmine would reverse a scopolamine inducedimpairment in choice accuracy in the DMTP task.

The dependent measures in the present study included percentage ofcorrect choices, the latency to make choice responses and the number oftrials which the animals were able to complete during the 70 min testsessions. Changes in the former measure may indicate changes in memoryand/or attentional function whereas changes in the latter two measuresmay be indicative of other non-cognitive effects of the drugs.

Fifty-six male Sprague Dawley rats, weighing between 200-290 g at thebeginning of training, were used. They were housed in groups of four percage and were each fed approximately 12-15 g of food per rat per day.This amount of food maintained the rats at approximately 85% of theirfree-feeding weight. Any animals which began to drop below this weightwere given additional food. Water was freely available. The animals weremaintained on a 12:12 hour light/dark cycle with the light periodbeginning at 6 a.m.

Twelve Campden Instruments operant chambers with two retractable leversand a centrally located food magazine were used for behavioural testing.A flap, which could be pushed back by the rat to enable it to obtainfood pellets, was positioned in front of the food magazine. The boxeswere modified so that partitions could be fitted either side of the foodmagazine. The partitions were clear Perspex, reaching from the gridfloor to the ceiling of the chamber and extending 105 mm into thecentral area. The operant boxes were contained in sound and lightattenuating shells. Paul Fray Control System Interlaces and an AcornA5000 computer programmed with Arachnid software was used to control theoperant equipment.

With the house light on throughout the session, rats were initiallytrained to retrieve Noyes 45 mg Formula ‘A’ food pellets from behind themagazine flap. Rats were then trained to press both the left and rightlevers to obtain food reward. Either the left or right lever wasrandomly presented during a 30 mm session. A response to the insertedlever resulted in the retraction of the lever, delivery of a food pelletand illumination of the magazine light. The magazine light remained onuntil the pellet was retrieved.

Matching to position training began next. This and all subsequenttraining was conducted with the partitions fitted into the operantboxes. The sessions were initially 50 minutes long. Rats were placed inthe operant box and the session began when the houselight wasilluminated. Following a 30 s intertrial interval (ITI), one of the twolevers (the sample lever) was inserted into the chamber. The leverremained inserted into the chamber until a lever-press responseoccurred. A response to the lever resulted in retraction of the leverand the illumination of the magazine light (but not pellet delivery). Assoon as the magazine flap was pressed the magazine light wasextinguished and both levers were inserted. A response to the samplelever (i.e., the same lever as was previously presented) resulted inretraction of both levers, delivery of a food pellet and theillumination of the magazine light. The magazine light remained on untilthe flap was pressed. A response to the incorrect lever (the oppositelever to that presented as the sample lever) did not produce a foodpellet and initiated a 10 s time-out (TO) period during which thehouselight was extinguished. A 30 s ITI was initiated before thecommencement of a new trial. The lever inserted as the sample lever wassemi-randomly determined such that the right and lefthand levers werepresented as the sample lever 8 times in a block of 16 trials.

A correction procedure was used throughout this and all subsequenttraining. The lever to be inserted (left or right) as the sample leverwas randomly determined by the computer on non-correction trials (i.e.,the first trial of the session and trials that immediately followed atrial on which a correct choice occurred). Each time an incorrectresponse occurred, the lever that was not chosen (i.e., the ‘correct’lever) was presented as the sample on the subsequent ‘correction’ trial.These correction trials prevented position habits (i.e., alwaysresponding on either the left or right lever and achieving 50% correct).The number of correction trials was recorded, but only the datacollected on the non-correction trials were used to evaluate thepercentage of correct choices.

Following 24 sessions, the animals were performing the matching toposition task with a high degree of accuracy. On Session 25 a variabledelay interval was interposed between the depression of the sample leverand presentation of the levers on the choice trial. After a response tothe sample lever, the choice levers were inserted following the firstflap press occurring after either a 0 s (immediate), 4, 8 or 16 s delay.The order of the four types of trials (0, 4, 8 or 16 s delay) wassemi-randomly determined with the constraint that in a 16 trial block,each delay occurred 4 times; twice on a left trial and twice on a righttrial. A limited hold was used such that if the rat did not make achoice response within 30 s of the end of the scheduled delay period,the trial was terminated and the intertrial interval began. Such a trialwas counted as incomplete and did not contribute to the data analysis.The same trial was reinstated following the end of the ITI. From Session25 onward the time-out period following incorrect choices was omittedand the session length was increased to 70 minutes.

Following 26 sessions with the 0-16 s delay (Session 25-50) theintertrial-interval was decreased to 10 s and, over the next 8 sessions(Session 51-58), a delay of up to 64 s was used. Due to poor performanceat the 64 s delay, however, this delay was not used in any furthersessions. On Session 59, delays of 0, 8, 16 and 32 s were used. Thesedelays were used in all subsequent sessions. Only 51 of the 56 ratscompleted more than 24 trials (correction plus non-correction) duringSession 59. These rats were selected and semi-randomly assigned to thefollowing 7 groups such that the groups were matched on performance(percent correct, response latency and number of trials completed):Vehicle/Vehicle (n=7), Vehicle/Scopolamine (n=), nepicastat 1.0mg/kg/Scopolamine (n=7), nepicastat 3.0 mg/kg/Scopolamine (n=7),nepicastat 10.0 mg/kg/Scopolamine (n=7), nepicastat 30mg/kg/Scopolamine, and Phys/Scopolamine (n=8).

At 6:00 am and 6:00 pm of the consecutive days during which Sessions60-69 were run, the rats received oral administration of either vehicle,physostigmine (Phys) or nepicastat (1, 3, 10 or 30 mg/kg). Due to thehigh degree of choice accuracy displayed by the vehicle treated animalsduring sessions 68 and 69, the 0, 8, 16 and 32s delay was also usedduring the final test session (Session 70) in which all but theVehicle/Vehicle treated group received 0.1 mg/kg of scopolamine HBradministered s.c. 30 minutes prior to testing. The animals in theVehicle/Vehicle group received a s.c. injection of saline 30 minutesprior to the final test session. Thus, the drug treatments administeredto the seven groups during the 11 consecutive days of the presentexperiment were:

Session 60-69 Session 70 Group (0, 8, 16, and 32 s delay) (0, 4, 8, and32 s delay) 1 Vehicle Vehicle/Vehicle 2 Vehicle Vehicle/Scopolamine 3nepicastat 1.0 mg/kg nepicastat 1.0 mg/kg/Scopolamine 4 nepicastat 3.0mg/kg nepicastat 3.0 mg/kg/Scopolamine 5 nepicastat 10 mg/kg nepicastat10 mg/kg/Scopolamine 6 nepicastat 30 mg/kg nepicastat 30mg/kg/Scopolamine 7 Physostigmine Physostigmine/Scopolamine

The data collected and analyzed in the present DMTP study include 1) thepercentage of correct responses; 2) the latency between performance of aresponse to the sample lever and the performance of the choice responseand 3) the total number of correction and non-correction trialscompleted. The former two dependent measures were collected for thenon-correction trials only.

In order to increase the power and sensitivity of the statisticalanalyses, during the first 10 drug treatment sessions (Session 60-69)the data were collapsed into two-session blocks (Block 1-5), althoughfigures for the data collected on Day 1-Day 10 of the study areincluded. Also, because the animals in the Vehicle/Vehicle and theVehicle/Scopolamine groups received the same treatment for the first 10days of testing, the animals in these two groups were combined for thepurpose of statistical analysis during Blocks 1-5.

Two-way analysis of variance (ANOVA) with drug treatment as thebetween-subjects factor and delay (0, 8, 16 or 32s) as thewithin-subjects factor was used to analyze percentage of correct choicesand response latency. These analyses were conducted separately for eachblock of data. Significant interactions were followed by a one-way ANOVAwhich was conducted at each delay. A significant main effect from aone-way ANOVA was followed by a two-tailed Dunnett's t-test. One-wayANOVA followed by a post hoc Dunnett's test, when appropriate, was usedto analyze the mean number of trials completed.

All the statistical tests were conducted on a Macintosh computer usingSuperAnova software. Alpha was set to 0.05 throughout. Animals whichwere unable to complete trials at each of the four delay periods wereexcluded from analyses of percentage of correct choices and responselatency. The number of animals that were included in the analysis ofpercentage of correct choices and latency to respond for each of the 5blocks of drug testing and on the scopolamine (scop) test day wererecorded. To assess the overall effects of the drugs on ability toperform the delayed matching to sample task, all animals were includedin the analysis of number of trials completed.

Physostigmine sulphate (1.0 mg/kg, supplied by RBI) and nepicastat (1,3, 10 and 30 mg/kg, supplied by Roche) were administered p.o. twicedaily starting at 6:00 am and 6:00 pm. Scopolamine HBr (0.1 mg/kg,supplied by Sigma) was administered s.c. 30 minutes prior to the lasttest session. Physostigmine and nepicastat were dissolved or suspendedin distilled water and injected in a volume of 2.5 ml/kg. ScopolamineHBr was dissolved in saline and injected in a volume of 1.0 ml/kg. Alldrug doses are expressed as base weight.

During the first block of testing, the drugs had no significant effectson percentage of correct choices or the latency to perform a choiceresponse in the DMTP task. Drug treatment also failed to affect thenumber of trials completed, F(5,45)=0.319, p=0.899.

In block 2, nepicastat and physostigmine had no significant effects onany of the dependent measures during this block of the test. Althoughthe effect was not statistically significant, F(5,45)=1.717, p=0.150,there was a trend towards a decrease in the number of trials completed.This apparent effect was slightly more marked in the groups treated witheither 3 or 30 mg/kg of nepicastat, and in the group treated withphysostigmine. In fact, during this block of training only 4 out of 7 ofthe animals treated with 30.0 mg/kg of nepicastat were able to completetrials at all of the four delays.

During block 3 of testing the animals treated with physostigminedisplayed a delay-independent impairment in choice accuracy. ANOVA onpercentage of correct choices revealed a significant main effect of drugtreatment, but the drug treatment X delay interaction failed to reachstatistical significance. A post hoc Dunnett's test on the main effectof drug treatment revealed that only the physostigmine treated groupsignificantly differed from the vehicle treated group. Drug treatmentdid not significantly affect response latency or number of trialscompleted, F(5,45)=0.701, p=0.625, during this block of testing.

The effects of drug treatment on percentage of correct choicesapproached, but failed to reach statistical significance in block 4(p=0.056). Drug treatment did, however, significantly impair responselatency with the ANOVA revealing a significant drug treatment X delayinteraction. Subsequent one-way ANOVAs conducted at the 0, 8, 16 and 32s delays found a statistically significant group effect at only the 32 sdelay; F(5,40)=2.115, p=0.084; F(5,40)=1.403, p=0.244; F(5,40)=2.259,p=0.067; F(5,40)=3.325, p=0.01±3, for the 0, 8, 16 and 32 s delays,respectively. A post hoc Dunnett's test at the 32 s delay found thatonly the group treated with 10.0 mg/kg of nepicastat had a longerlatency to perform the choice response than did the vehicle treatedgroup. Drug treatment did not significantly affect the number of trialscompleted during Block 4 of the test, F(5,45)=1.533, p=0.199.

During block 5 of testing nepicastat induced a marked dose- anddelay-dependent impairment in choice accuracy. Two-way ANOVA revealed asignificant drug treatment X delay interaction and subsequent one-wayANOVAs at the 0, 8, 16 and 32 s delays found a significant groupdifference in percentage of correct choices at only the 32 s delay,F(5,39)=0.327, p=0.894; F(5,39)=0.825, p=0.539; F(5,39)=1.188, p=0.333;F(5,39)=3.018, p=0.021, for the 0, 8, 16 and 32 s delays, respectively.A post hoc Dunnett's test conducted at the 32 s delay found that boththe 10 and the 30 mg/kg nepicastat treated groups showed impairments inpercentage of correct choices relative to the vehicle treated animals.

Nepicastat and physostigmine did not significantly affect responselatency or number of trials completed, F(5,45)=1.692, p=0.156, duringBlock 5 of the test.

Many of the animals did not perform the delayed matching to sample testafter administration of scopolamine HBr. Only 1 rat treated with 10.0mg/kg of nepicastat plus scopolamine, and only 2 rats treated with 30.0mg/kg of nepicastat plus scopolamine were able to complete trials ateach of the four delays. In fact n<4 occurred in all the groups exceptfor the Vehicle/Vehicle and the Vehicle/Scopolamine in which seven andfour rats, respectively, completed trials at each of the four delays.

The number of trials completed by the animals in all of the scopolaminetreated groups was significantly reduced, F(6, 16)=8.801, p=0.001.

Due to the small number of subjects in the scopolamine treated groups,the choice accuracy and the response latency data were not subjected toANOVA. In addition, the mean percentage of correct choices collapsedacross the four delays. A t-test comparing the choice accuracy in theVehicle/Scopolamine group to the Vehicle/Vehicle group found thatscopolamine significantly impaired percentage of correct choices,t₍₉₎=4.15, p=0.003. With fewer than 4 subjects in the other groups,further statistical analyses were not conducted. It is interesting tonote, however, that the two animals in the group given 30.0 mg/kg ofnepicastat plus scopolamine performed well compared to the group treatedwith scopolamine alone: both of the animals treated with 30.0 mg/kg ofnepicastat plus scopolamine made more correct choices than any of theanimals in the Vehicle/Scopolamine treated group or any of the animalsin the other scopolamine treated groups.

Nepicastat when administered alone does not appear to induce memoryenhancing effects in the DMTP test. It is notable that the delay inducedmemory impairment observed in the vehicle treated control animalsappeared to dissipate across the five blocks of testing. However, by thefifth block of testing the vehicle treated control animals were stillshowing a delay-dependent memory impairment with 100% choice accuracy atthe 0 s delay and 80% choice accuracy at the 32 s delay. Thus, a ceilingeffect in the performance of the vehicle treated animals at the 32 sdelay was not observed.

Notably, by the fifth block of training nepicastat may have selectivememory disrupting effects. Physostigmine did not improve performance onany of the treatment days and actually produced a delay-independentimpairment in choice accuracy during Block 3 of testing (Days 5 & 6).The results from a scopolamine challenge test on day 11 in which theanimals were co-administered scopolamine HBr (0.1 mg/kg) and nepicastator physostigmine could not be analyzed due to the small number ofsubjects in the nepicastat and physostigmine treated groups that wereable to perform the DMTP task. However, two rats receiving 30.0 mg/kg ofnepicastat and scopolamine that were able to perform the DMTP taskdisplayed a higher choice accuracy than any of the other scopolaminetreated animals. It is possible that nepicastat is capable of reversingsome of the cognitive disruption induced by scopolamine, an effect thatmay be masked by other “non-cognitive” actions of the compound.

Nepicastat induced significant dose- and delay-dependent impairments inchoice accuracy. The animals treated with 10.0 mg/kg of nepicastatshowed absolutely no impairments in choice accuracy at the 0, 8 and 16 sdelays. In contrast, at the 32 s delay, the animals in the 10.0 mg/kgnepicastat group were impaired relative to the vehicle treated group.The group treated with the highest dose of 30.0 mg/kg of nepicastatshowed no impairments in choice accuracy at the 0 s delay, a tendency toimpaired choice accuracy at the 8 and 16 s delays and a significantimpairment in choice accuracy relative to the vehicle treated groups atthe 32 s delay. The delay-dependent nature of these drug-inducedimpairments in choice accuracy suggests that the compound may be actingdirectly on short-term or working memory. The animals are sufficientlymotivated and able to accurately perform the DMTP task at the shorterdelays and show impairments only when the retention interval is long.Few compounds that have been tested in this model have shown thisprofile. Many compounds which have been claimed to impair memorytypically induce impairments in choice accuracy which is observed at alldelays (e.g., MK-801, scopolamine). Nepicastat had a small effect onlatency to complete trials which was apparent on the fourth block oftraining, during which the animals treated with 10.0 mg/kg of nepicastattook longer to completed the 32 s delay trials than the vehicle treatedanimals. This effect was not dose-dependent and was not observed in thegroup treated with 30.0 mg/kg. There was also a trend for the animalstreated with nepicastat to complete fewer trials than the vehicletreated animals: trends for reductions in number of trials completedwere observed during the last two blocks of training. Due to thevariability in the data, however, these trends did not reach statisticalsignificance. This variability in the data was unexpected. It appearslikely that the initial stress induced by the chronic oral dosing regimemay have disrupted the performance of these food-deprived animals,particularly during the first few blocks of the experiment. All of thegroups showed reductions in the number of trials completed between thefirst and second block of training. The animals recovered from thisinitial decline and showed more consistent performance across the nextthree blocks of training.

We found that some of the animals in this study began to lose weight, insome cases in excess of 5% of total body weight. Animals which wereshowing weight loss were separated and given additional food at the endof their daily training session. This extra feeding may have contributedto the variability in number of trials completed. Although systematicrecordings were not made, casual observation suggested that more animalsin the 30 mg/kg group than in the other groups had to be givenadditional food. This observation is consistent with the results of apilot study in which daily administration of 100 mg/kg p.o. ofnepicastat induced a marked loss of body weight.

Physostigmine did not improve performance of the rats in the DMTP test.In fact, the animals treated with physostigmine showed a significantimpairment in percentage of correct choices during Block 3 of training.In contrast to the effects obtained with nepicastat, the impairment inchoice accuracy induced by physostigmine was delay-independent: theinteraction term from the analysis of variance did not approachstatistical significance. Thus, the effects of physostigmine on responseaccuracy are likely to be secondary to behaviorally toxic effects of thedrug when it is administered at this dose. The animals appeared todevelop tolerance to these effects over the last two blocks of trainingduring which the impairments in choice accuracy induced by physostigmineno longer reached statistical significance.

Finally, physostigmine did not appear to reverse the effects ofscopolamine during the scopolamine test. It is possible that a differentdose of physostigmine may have been effective against scopolamine. Wehave not previously attempted to reverse scopolamine with physostigmineusing the present dosing regime and therefore have no historical data tocompare with the present results. This lack of effect of physostigminemay be due to the fact that, compared with acute administration, a lowerdose of physostigmine had to be employed for chronic administration. Theanimals would not have tolerated repeated administration of a higherdose of physostigmine (see results of the pilot study) which may berequired to reverse the effects of scopolamine. In addition, nepicastatdid not appear to reverse the effects of scopolamine although it isinteresting that the two animals treated with 30.0 mg/kg of nepicastatthat were able to perform during the scopolamine test showed higherchoice accuracy than any of the animals in any of the other scopolaminetreated groups. Further research would be needed to determineunequivocally whether acute or chronic treatment with nepicastat canreverse the effects of scopolamine in this test.

Nepicastat appears to have specific memory-disrupting effects which areapparent after 8 days of dosing. Physostigmine did not improveperformance on any of the treatment days and actually produced adelay-independent impairment in choice accuracy during Block 3 oftesting (Days 5 & 6). The results from a scopolamine challenge test onday 11 in which the animals were co-administered scopolamine HBr (0.1mg/kg) and nepicastat or physostigmine could not be analyzed due to thesmall number of subjects in the nepicastat and physostigmine treatedgroups that were able to perform the DMTP task. However, two ratsreceiving 30.0 mg/kg of nepicastat and scopolamine that were able toperform the DMTP task displayed a higher choice accuracy than any of theother scopolamine treated animals. It is possible that nepicastat iscapable of reversing some of the cognitive disruption induced byscopolamine, an effect that may be masked by other “non-cognitive”actions of the compound. On the final block of training, nepicastatinduced dose- and delay-dependent impairments in choice accuracy. Thisis an unexpected finding given that many other memory disrupting drugs,such as scopolamine and MK-801, induce delay-independent impairments inchoice accuracy that are probably due to impairments in attention and/ormotor/motivational factors. In contrast, it is unlikely, that changes inattention or motor/motivation performance could account for the presentresults with nepicastat. If this drug is selective for a novel receptoror pharmacological mechanism, these results suggest an important rolefor this substrate in working memory.

Example 30

Recently we have demonstrated that nepicastat, a selective dopamineβ-hydroxylase inhibitor, exhibited an effective antihypertensiveactivity in acute studies in SHRs. The antihypertensive effects ofnepicastat were examined chronically in the same strain of rats.Furthermore, we also explored the possible potentiation effects of theco-administration of the compound with the angiotensin converting enzymeinhibitor enalapril. Effects of the treatments on the cardiachypertrophy in SHRs were also examined.

Male SHRs/NCr1 BR rats (22-28 weeks old at the onset of dosing), andweight matched WKY/NCrI BR rats were used. Four series of experimentswere conducted sequentially:

Vehicle Series I Enalapril 10 mg/kg nepicastat 3 mg/kg nepicastat 10mg/kg Series II Enalapril 10 mg/kg nepicastat 30 mg/kg nepicastat 100mg/kg Series III Enalapril 1 mg/kg nepicastat 30 mg/kg nepicastat 30mg/kg + enalapril 1 mg/kg Series IV Enalapril 1 mg/kg (E1) nepicastat 15mg/kg + E1 nepicastat 30 mg/kg + E1 nepicastat 60 mg/kg + E1

In each series, 24 SHRs were chronically implanted with telemetryimplants for measurement of arterial blood pressure, heart rate andmotor activity. The rat was anesthetized with pentobarbital sodium (60mg/kg, i.p.) and its abdomen shaved. Under aseptic conditions, anincision was made on midline. The abdominal aorta was exposed, andcannulated with the catheter of a telemetry transmitter unit. After thetransmitter was sutured to the abdominal musculature, the skin wasclosed. Each rat was allowed to recover for at least 2 weeks beforebeing subjected to drug administration. The rats were housedindividually in a quiet room with reversed light/dark cycle(08:00-20:00, lights off.)

Three days prior to the start of the experiment, the rats were randomlydivided into 4 groups and their systolic blood pressure (SBP), diastolicblood pressure (DBP), mean blood pressure (MBP), heart rate (HR), andmotor activity (MA) were monitored. After the predose values for theseparameters were established, respective groups of rats received a 30 daydaily treatment of nepicastat and/or enalapril (see below).

Twenty-four hrs after the last treatment, the rats were sacrificed andthe left ventricles were collected, weighted (wet weight), andlyophilized for at least 24 hr to obtain dry weights.

At the start of each experiment, the number of rats in each groupundergoing telemetry monitoring was always 6. In Series I, however, 7Wistar Kyoto (WKY) rats were similarly housed and dosed with vehicle(water), while in Series III and IV an additional 2 rats in each groupwere similarly treated (to increase the numbers of animals forstatistical analysis on effects on the hypertrophy of SHRs). Notelemetry instrumentation or monitoring was conducted on these rats.

Both nepicastat and enalapril were prepared in water. All doses weregiven orally to the rat in 10 ml/kg and were expressed as free baseequivalents. Enalapril (VASOTEC®) was obtained commercially from a localpharmacy.

A computerized data collection system was used to continuously collectdata on SBP, DBP, MBP, HR, and MA. Data on each rat were collected every5 min. for 10 sec. These were then averaged hourly and standard errorsof the mean (SEM) calculated. At the end of the treatment, leftventricular mass (dry and wet weights) were obtained. Body weights wererecorded daily.

All values were expressed as means SEM. Statistical significance wasdefined as a p level of less than 0.05.

Data on MBP, HR and MA were analyzed separately. Each analysis was doneon 26 time points measured each thy. A two-way ANOVA with main effectsfor treatment and time and their interaction was used. If an overalltreatment effect or a significant interaction was detected, a series ofone-way ANOVA at each time point would be performed. The pairwisecomparisons at each time point were performed using Dunn's procedure. Ifno overall treatment effect was detected, then the pairwise differencefrom control would be performed by adjusting the critical value using aBonferroni adjustment.

For left ventricular mass, an analysis of covariance with a covariate offinal body weights was used to analyze tissue wet weights and tissue dryweights, while Kruskal-Wallis test was used to analyze ratios of tissuewet weight/body weight and tissue dry weight/body weights. If an overalltreatment effect among all groups was not detected, Bonferron'sadjustment to multiple comparisons was then made.

For body weight a two-way ANOVA with respect to the changes frompre-dose was used to analyze overall effects for treatment, day, andtreatment by day interaction. Then a one-way ANOVA was performed foreach day, and pairwise comparisons for the drug-treated groups to thevehicle controls were made using Dunn's procedure and Fisher's LSDstrategy to adjust for multiple comparisons.

For series I and II, Oral administration of nepicastat at 3 and 10 mg/kg(all doses expressed hereafter are po) did not significantly affectblood pressure on any of the 30 day treatment (data not shown). At 30mg/kg, nepicastat gradually lowered MBP on day 1 and continued to lowerthe MBP to a maximal of −20 mmHg on day 3 (p<0.01), with little recoverywithin 24 hr. Similar antihypertensive effects were induced throughoutthe study. At 100 mg/kg, the compound induced a peak antihypertensiveresponse of −29 mmHg 21 hr after dosing on day 1 (p<0.01). MBP continuedto decrease and reached its nadir of approximately −42 mmHg on day 3(p<0.01). The MBP remained low throughout the study.

Enalapril at 10 mg/kg, consistently lowered MBP throughout the study. Amaximal decrease of −29 mmHg (p<0.01) in MBP was observed within 1 hrafter dosing on day 5.

In series III, although mono-administration of enalapril at 1 mg/kg(n=6) or nepicastat at 30 mg/kg (n=6) induced only a smallantihypertensive effect, the co-administration of the two compounds(n=6) induced a greater antihypertensive response (−21 mmHg at hr 16 onday 1, p<0.01). The onset of the response was slow and gradual. With asecond administration on day 2, a greater antihypertensive response wasobserved most of the day with combined treatment (−25 mmHg at hr 13,p<0.01). The potentiation was observed throughout the study.

In series IV, potentiation of the effects of nepicastat by anon-antihypertensive dose of enalapril was studied further. In thepresence of enalapril (1 mg/kg), although nepicastat at 60 mg/kginitially produced a greater and longer antihypertensive effect thanthose induced by the compound at 15 or 30 mg/kg, no greater effect wasobserved on day 8 through day 30. Thus, the potentiation was not relatedto the doses of nepicastat tested (15, 30 and 60 mg/kg). The group thatreceived nepicastat 15 mg/kg and E1 exhibited low average mean bloodpressure with a large standard error (two rats showed greaterantihypertensive responses than the rest).

Nepicastat at 3 and 10 mg/kg, did not consistently affect heart rate(HR) in the 30 day studies. The groups treated with nepicastat at 100mg/kg, however, tended to exhibit lower HR than the vehicle controlgroup, at least in the first few hours after dosing. Although enalaprilat 1 mg/kg did not affect HR, the compound at 10 mg/kg tended to inducea transient small tachycardia within 2 hr after dosing. In Series III,none of the treatments, i.e., enalapril (1 mg/kg), nepicastat (30 mg/kg)or the combination, consistently affected HR. In Series IV, the groupstreated with nepicastat (15, 30 and 60 mg/kg) and enalapril (1 mg/kg)tended to exhibit lower HR than the group treated with enalapril (1mg/kg) alone.

Throughout the study, none of the drug treatments showed a significanteffect on motor activity (MA).

Nepicastat at 3-100 mg/kg did not affect the cardiac hypertrophyobserved in SHRs (p>0.05). Enalapril (10 mg/kg) significantly reducedleft ventricular mass in Series II, but not in Series I. In Series III,enalapril at 1 mg/kg did not regress the hypertrophy, but theco-administration of enalapril (1 mg/kg) and nepicastat (30 mg/kg)significantly decreased the left ventricular mass of the SHRs (p<0.01).In Series IV, however, effects of co-administration of enalapril (1mg/kg) and nepicastat at 15, 30 and 60 mg/kg on the left ventricularmass were not different from enalapril alone (p>0.05).

Compared to that treated with vehicle, treatment of the SHRs withnepicastat at 3 and 10 mg/kg did not have any effect on body weights inSHRs (p>0.05). Treatment with the compound at 30 and 100 mg/kg, however,induced greater increases in body weight (p<0.05).

In comparison, enalapril at 10 mg/kg significantly decreased (p<0.05) orhad no effect on the body weights of the rat. Although treatment withenalapril at 1 mg/kg slightly decreased body weight, co-administrationof enalapril (1 mg/kg) and nepicastat (30 and 60 mg/kg) slightlyincreased the body weights of the rat.

The pre-dose body weights of the rats treated with vehicle, enalapril,and nepicastat at 3 and 10 mg/kg were 387±11, 415±12, 407±4, and 41512g, respectively.

The pre-dose body weights of the rats treated with vehicle, enalapril,and nepicastat at 30 and 100 mg/kg were 399±10, 389±6, 389±9, and 401±10g, respectively.

The pre-dose body weights of the rats treated with vehicle, enalapril,and nepicastat at 30 mg/kg without and with enalapril were 365±9, 371±8,361±7, and 3697 g, respectively.

The pre-dose body weights of the rats treated with enalapril alone andco-administrations of nepicastat at 15, 30, and 60 mg/kg were 3576,363±6, 347±8, and 346±8 g, respectively.

Four deaths were observed in the 4 series of 30-day treatments. Thecauses of these deaths were undetermined, but it appeared unlikely thatthese deaths were related to the treatment of nepicastat.

The effects of 30-day chronic oral administration of nepicastat on bloodpressure, heart rate, motor activity and left ventricular mass wereevaluated in four series of experiments in spontaneously hypertensiverats (SHRs) with radio-telemetry implants. Daily treatment of nepicastatat 3 and 10 mg/kg (n=6) did not affect blood pressure. Nepicastat at 30mg/kg (n=6) induced a peak antihypertensive effect of −20 mmHg on day 3(p<0.01). The antihypertensive effect was modest but were detectedthroughout the study. At 100 mg/kg, nepicastat (n=5) induced a greaterantihypertensive effect. The effect was gradual and reached its peak of−42 mmHg on day 3 (p<0.01). Comparable magnitudes of antihypertensiveeffects were observed for the rest of the study. In comparison, theangiotensin converting enzyme inhibitor enalapril (10 mg/kg, n=6)induced an antihypertensive effect of −20 to −30 mmHg throughout thestudy. Although mono-administration of enalapril (1 mg/kg) did notinduce significant antihypertensive effects, the co-administration withnepicastat (30 mg/kg; n=6) induced a greater and long-lastingantihypertensive effect (p<0.01). The potentiation was observedthroughout the 30-day study. The potentiation of the antihypertensiveeffects of nepicastat by enalapril (1 mg/kg) was also seen at doses of15, 30, and 60 mg/kg, although these effects were not dose dependent.

In groups treated with nepicastat at 3-10 mg/kg or enalapril at 1 mg/kg,no significant effects on heart rate were observed. The groups thatreceived nepicastat at 30 or 100 mg/kg, however, exhibited slightbradycardia during the awake hours of the rat. In contrast, enalapril at10 mg/kg induced a transient tachycardia. Co-administration ofnepicastat (15, 30, and 60 mg/kg) and enalapril (1 mg/kg) tended toexhibit slower heart rate than enalapril (1 mg/kg) alone. In any of thetreatment groups, no significant effect on motor activity was detected.

Treatment with nepicastat at 30 (n=6) and 100 (n=5) mg/kg did not havesignificant effects on the left ventricular hypertrophy observed inSHRs. Although enalapril (1 mg/kg, n=8) or nepicastat (30 mg/kg, n=7)alone did not regress the hypertrophy, the co-administration of the twocompounds (n=8) significantly decreased the left ventricular mass of theSHRs. The effect of co-administration on left ventricular mass, however,was not dose related to nepicastat (15, 30 and 60 mg/kg) and was notstatistically different from that of enalapril (1 mg/kg) alone.

In the four series of experiments, four deaths occurred during thecourse of the 30 day treatments. Three rats were found in groups treatedwith nepicastat and one with vehicle. The causes of death wereundetermined, but appeared unrelated to the treatment of nepicastat.

Nepicastat significantly reduced blood pressure in SHRs over the 30-dayperiod at 30 and 100 mg/kg without causing any reflex tachycardia.Co-administration of nepicastat (30 mg/kg) with a non-antihypertensivedose of enalapril (1 mg/kg) had a greater anti-hypertensive effect and agreater effect on regression of hypertrophy in SHRs than nepicastattreatment alone. These effects, however, were not dose related tonepicastat (15, 30 and 60 mg/kg).

Example 31

A study was conducted to evaluate the effects of nepicastat on responsesto autonomic agents in anesthetized, instrumented dogs.

Beagle dogs were administered single intraduodenal doses of 0 (vehicle)or 60 mg/kg of nepicastat through an intraduodenal cannula. Thevehicle-control group consisted of 1 male and 1 female, and thenepicastat-treatment group consisted of 2 males and 2 females. Eachanimal was surgically instrumented while anesthetized with isofluranegas. Before dosing with test formulation, the average blood pressureresponses to intravenous doses of autonomic agents, norepinephrine (3μg/kg), isoproterenol (0.3 μg/kg), and acetylcholine (10 μg/kg), wereevaluated. A single bolus dose of test formulation was then administeredto each animal and the blood pressure responses to the autonomic agentswere evaluated approximately 1, 2, and 3 hours after dosing. At thecompletion of the experiment, each dog was euthanatized and removed fromthe study.

The dog was selected because it is commonly used to evaluate the effectsof test compounds on hemodynamic parameters. Beagle dogs were obtainedfrom Marshall Farms, Inc., North Rose, New York. Each dog was identifieduniquely by an ear tattoo applied by the vendor. The animals wereacclimated to laboratory conditions at least 3 weeks before dosing.During the acclimation period, the general condition of each animal wasevaluated and those considered healthy were used. The dogs were randomlyassigned to treatment groups; males were assigned odd numbers andfemales were assigned even numbers.

After assignment to the study, the dogs were housed individually instainless steel cages identified with the study number, animal number,and tattoo number. The room housing the dogs was environmentallycontrolled. The cages were cleaned daily and the animals weretransferred into sanitized cages every other week. PURINA CERTIFIEDCANINE CHOW® was offered once daily and water was provided ad libitum.

On the day of treatment, the dogs were approximately 14 to 16 monthsold. Males weighed 10.3 to 12.9 kg and females weighed 8.5 to 11.2 kg.

At the time of dosing, a 60-mg/ml suspension was prepared by mixingnepicastat powder with vehicle. The constituted 60-mg/ml nepicastatformulation retained potency for the duration of use. On each day ofdosing, aqueous solutions of norepinephrine (60 μg/ml), isoproterenol (6μg/ml), and acetylcholine (200 μg/ml) were prepared in sterile water.

A vehicle-control group of 1 male and 1 female were administered 1 ml/kgof vehicle and a nepicastat-treatment group of 2 males and 2 femaleswere administered 1 ml/kg of a 60 mg/ml nepicastat solution. The totaldose of nepicastat administered to each animal was 60 mg/kg.

Dose selection was based on data from two studies with nepicastat. In anacute toxicity study in dogs, a single oral dose of 400 mg/kg resultedin transient clinical signs of toxicity. In a 1-month study, doses of 5,20, or 80 mg/kg were administered to dogs orally once daily. Clinicalsigns of toxicity were present at 80 mg/kg/day.

A single intraduodenal dose of vehicle or nepicastat formulation wasadministered directly into the duodenum through an intraduodenalcannula. The intraduodenal route was selected because the oral route isa proposed clinical route of administration of nepicastat. Dose volumeswere calculated on the basis of individual body weights recorded beforedosing (data not tabulated in this report). At the end of eachexperiment, the dog being evaluated was euthanatized by an overdose ofsodium pentobarbital (300 mg/kg, IV) and removed from the study.

The dogs were surgically instrumented according to procedures describedin the protocol. Food was withheld from the animals overnight beforesurgical instrumentation. Each animal being evaluated was initiallyanesthetized by injecting (IV) a mixture of ketamine (10 mg/kg) anddiazepam (0.5 mg/kg). Each animal was placed on a surgical table on topof a circulating warm-water pad to maintain body temperature andmechanically ventilated throughout the experiment. A surgical plane ofanesthesia was maintained with isoflurane gas (1.5% to 2% of tidalvolume delivered in oxygen at a flow rate of approximately 1.5L/minute). Rectal body temperature was monitored only for use inmeasuring blood gas levels and the data are not presented in thisreport. External needle electrodes were placed subcutaneously to monitora standard limb lead II electrocardiogram (ECG) for assessinganesthesia.

The left femoral vein was cannulated and the tip of the polyethylenetubing was advanced into the vena cava for administration of autonomicagents. The left femoral artery was cannulated using a polyethylene tubefilled with 50 U/ml of heparin-saline solution. The tip of the arterialcannula was advanced into the thoracic aorta and coupled to an externalpressure transducer and systolic and diastolic aortic pressure wererecorded. Arterial blood samples were withdrawn from the arterialcannula for blood pH, PCO₂, and PO₂ analyses.

A midline laparotomy was performed and the duodenum was isolated justcaudal to the pyloric sphincter. A needle was inserted into the duodenumand the tip of a saline-filled cannula was advanced through the needleand into the lumen for test formulation administration. The needle waswithdrawn from the incision site, the cannula was anchored intoposition, the cannula's stopcock was exteriorized outside of theabdomen, and the skin of the abdominal incision was reapposed.

Following surgical instrumentation, ventilatory adjustments were made,if necessary, to bring arterial blood pH and PCO₂ levels withinapproximately normal physiological ranges (pH=7.43 to 7.50 and PCO₂=22to 27 mmHg).

The autonomic agents, norepinephrine (3 μg/kg), isoproterenol (0.3μg/kg), and acetylcholine (10 μg/kg), were administered intravenously bybolus injection (over approximately 15 seconds) using the femoral veincannula with approximately 10 minutes between each dose. Following eachadministration of an agent, the cannula was flushed with 3 ml of water.Administration of the agents was repeated approximately 20 minutes afterthe first administration of acetylcholine.

Approximately 30 minutes after the second administration ofacetylcholine, each animal was dosed with vehicle or nepicastat. Thedose volume was 1 ml/kg given as a bolus directly into the duodenumusing the intraduodenal cannula. Immediately after dosing, theintraduodenal cannula was flushed with 3 ml of vehicle solution.Approximately 50, 110, and 170 minutes after dosing, administration ofthe autonomic agents was repeated with approximately 10 minutes betweenadministration of each agent.

Aortic blood pressure, heart rate, and ECG parameters were continuouslyrecorded directly on a polygraph recorder. The blood pH, PCO₂, and PO₂values from the blood gas analyzer were manually recorded onto thepolygraph chart at the approximate time at which the blood samples werewithdrawn. Heart rate, ECG, and blood gas parameters were used only forassessing the level of anesthesia and the stability of the animalpreparation; these data are not presented in this report.

Systolic, diastolic, and mean aortic blood pressures were evaluated justbefore administration (baseline) and at the time of peak response toeach agent (maximum change from baseline). Systolic, diastolic, and meanaortic blood pressures, and blood pH, PCO₂, and PO₂ were evaluatedbefore dosing and approximately 50, 110, and 170 minutes after dosingwith test formulation.

The responses to norepinephrine were characterized by evaluating themean aortic blood pressure just before and at the time of peak pressureincrease for each norepinephrine administration. The responses toisoproterenol and acetylcholine were characterized by evaluating thediastolic aortic blood pressure just before and at the time of peakpressure decrease for each isoproterenol and acetylcholineadministration.

At the end of the experiment, each dog was euthanatized by an overdoseof sodium pentobarbital (approximately 300 mg/kg, IV) and removed fromthe study.

No treatment-related differences between predose and postdose responsesto norepinephrine were present. In vehicle-control dogs, the postdoseresponses to norepinephrine were of lesser magnitude than the predoseresponses; this was considered incidental. No treatment-relateddifferences between predose and postdose responses to isoproterenol werepresent. No treatment-related differences between predose and postdoseresponses to acetylcholine were present.

Surgically instrumented, anesthetized beagle dogs were administered asingle intraduodenal dose of 60 mg/kg of nepicastat. Blood pressureresponses to intravenous doses of autonomic agents (norepinephrine,isoproterenol, and acetylcholine) were evaluated before dosing andapproximately 1, 2, and 3 hours after dosing. No treatment-relateddifferences between predose and postdose responses to autonomic agentswere present.

Example 32

The effects of acute intraperitoneal administration of nepicastat, a DBHinhibitor (DBHI), on locomotor activity in mice. It has been suggestedthat compounds of this class have effects on locomotor activity.

Adult male CD-1 (ICR) mice (30-40 g on study day) were housed in groupsof eight under a normal light/dark cycle with lights on between 0900 hrand 2100 hr. Food and water were allowed ad libitum. All animals werenaive to drug treatment and behavioral testing. Each animal was onlyused once.

Locomotor activity was monitored in an automated 14 station activitymonitoring system (San Diego Instrument Co.). Each station consisted ofa clear perspex cage (25 cm×45 cm×20 cm; w×l×h) placed within a metalframe containing 3 photoemmitors and 3 photodetectors spaced equallyalong the length of the wall. The bottom of each cage was lightlycovered in clean cedar bedding.

The mice were placed in the testing room at least 1 hr prior to testing.The mice were placed individually into one of the activity cages andallowed to explore for 30 min. Following this habituation period, themice were dosed intraperitoneally with either nepicastat (10, 30 and 100mg/kg), SKF-102698 (30 and 100 mg/kg), cocaine (30 mg/kg) or vehicle andreturned immediately to same cage. Following a 60 minute pre-treatmentperiod, motor activity was monitored for 180 minutes. Activity countsand ambulations (defined as a break of 2 consecutive photobeams) foreach animal were recorded every 30 minutes.

A repeated measures two-way analysis of variance (ANOVA) was performedusing the overall ranked data (nonparametric technique) to test for theoverall effects of treatment, time interval and treatment by timeinterval interaction. At each time interval, a one-way ANOVA wasperformed to see at which of the intervals, in any, treatment effectsexisted. Pairwise comparisons were then performed at each time intervalusing Dunn's procedure and Fisher's LSD strategy to adjust for theproblem of multiple comparisons.

For nepicastat, the dose range was 3-100 mg/kg and was dissolved in dH₂Oand sonicated. For SKF-102698, the dose range was 30-100 mg/kg. Forcocaine hydrochloride, the dose was 30 mg/kg. Compounds wereadministered in a volume of 1 ml/100 g. All doses reported arerepresented as the free base, except for cocaine in which the saltweight was used.

In the overall model, there was a significant effect for both treatmentand time (both p<0.01) while the treatment by time interaction was notsignificant. The analysis at each time point revealed that there weresignificant overall treatment effects at time intervals 1-4 (i.e., thefirst 120 minutes of testing; all p<0.01) while no overall significanttreatment effect was detected at time intervals 5 and 6 (i.e., the last60 minutes of testing).

When comparing the cocaine to the vehicle group with respect to bothactivity counts and ambulations, there was a significant overall effectsfor treatment and time (both p<0.01) while the treatment by timeinteraction was not significant. The analysis at each time intervalrevealed the cocaine group had significantly greater total activitycounts and a significantly greater number of ambulations at timeintervals 1-4, but not 5 and 6 (all p<0.05).

In contrast, there were no significant differences in either the totalactivity counts or the ambulations for any of the nepicastat-treatedgroups or the SKF-102698-treated groups compared to vehicle control atany time interval.

Cocaine was effectively demonstrated as a locomotor stimulant at thedose of 30 mg/kg. In contrast, acute administration of nepicastat atdoses of 3, 10, 30 or 100 mg/kg did not cause any significant change intotal activity or the ambulations at any time interval, as compared tovehicle control. Similarly, SKF-102698 at doses of 30 and 100 mg/kg hadno significant effects on total activity or ambulations at any timeinterval examined. These data suggest that these DBHI are devoid ofmotoric actions in mice.

Example 33

Acute dosing with the dopamine-β-hydroxylase inhibitor nepicastat hasbeen shown to inhibit the enzyme in the mesenteric artery and leftventricle in spontaneously hypertensive rats. Changes in norepinephrineand dopamine levels in the spontaneous hypertensive rat brain cortex andmesenteric artery after 7 and 25 days of oral administration of 1 mg/kgor 10 mg/kg nepicastat were examined.

Nepicastat at 1 and 10 mg/kg was prepared in terms of the free base. Theweighings were dissolved in vehicle (dH₂O) to yield oral doses thatcould be administered in a volume of 10.0 ml/kg.

Male spontaneous hypertensive rats (SHRs), 16-17 weeks old at the onsetof the study, were used. Animals were allowed food and water ad libitum.Animals were randomly assigned to one of the following treatment groups:oral administration of nepicastat at 10 mg/kg, 1 mg/kg, or a vehiclegroup of deionized water at 10 ml/kg. Rats were dosed orally once a dayfor 7 or 25 days with vehicle, 1 mg//kg or 10 mg/kg nepicastat (n=8)except for day 25, where n=9. On day 7, four hours after compoundadministration, animals were anesthetized with halothane, decapitatedand the cortex and mesenteric artery were harvested, weighed, andanalyzed from 24 rats (n=8/treatment group). The remaining 31 ratscontinued receiving oral administration with one of the three treatmentsfor the following 18 days. At 4 hours after the last treatment themesenteric artery and cortex from this group were harvested, weighed,and analyzed for catecholamine levels.

The animals sacrificed on day 25 were also used for blood pressuremeasurements. The last blood pressure measurement was made on day 22.

Statistically, the three treatments were compared at each time period (7or 25 days) using a non-parametric one-way analysis of variance (ANOVA).Pairwise comparisons of each treatment with control were performed usingFisher's LSD strategy on the means, adjusted for differences in samplesize, to control the experiment-wise error rate. Each variable wasanalyzed separately. For FIGS. 6-11, *, p<0.05 and **, P<0.01.

In the cerebral cortex, after seven days of treatment, the 10 mg/kg dosegroup had significantly (p<0.1) lower norepinephrine levels and asignificantly (p<0.05) higher dopamine/norepinephrine ratio compared tothe vehicle group. There were no significant (p>0.05) differences indopamine levels compared to vehicle in either of the two treatmentgroups (1 or 10 mg/kg nepicastat), or in the norepinephrine levels orthe dopamine/norepinephrine ratio of the 1 mg/kg nepicastat dose group,after seven days of treatment (FIGS. 6-8). There was a slightsignificant (p<0.05) increase in the cortex dopamine/norepinephrineratio at day 7 with the 10 mg/kg nepicastat dose.

After 25 days of treatment, cortex levels of dopamine in the 1 mg/kgnepicastat dose group were significantly (p<0.05) higher compared to thevehicle group. The cortex dopamine/norepinephrine ratio in this groupwas also significantly (p<0.01) greater than the vehicle ratio. Theratio of the 10 mg/kg nepicastat dose group was significantly greater(p<0.05) compared to vehicle. Norepinephrine levels in either dose groupwere not significantly (p.>0.05) different than control, nor were thedopamine levels in the 10 mg/kg dose group (FIGS. 6-8).

In the mesenteric artery, after both 7 days (p<0.05) and 25 days(p<0.01) of dosing, the 10 mg/kg dose group had significantly higherdopamine levels and dopamine/norepinephrine ratios compared to thevehicle group, but there were no differences in norepinephrine levels.None of the parameters measured were significantly (p<0.05) differentthan control in the 1 mg/kg nepicastat dose group (FIGS. 9-11).

Nepicastat, administered orally for 7 and 25 days, significantly(p<0.05) inhibited dopamine-β-hydroxylase in the cortex and mesentericartery of spontaneously hypertensive rats (SHRs). Greater inhibition wasseen with administration of 10 mg/kg nepicastat compared to 1 mg/kg,therefore the effects observed were dose dependent.

It will be readily apparent to one of ordinary skill in the relevantarts that other suitable modifications and adaptations to the methodsand applications described herein are suitable and may be made withoutdeparting from the scope of the invention or any embodiment thereof.While the invention has been described in connection with certainembodiments, it is not intended to limit the invention to the particularforms set forth, but on the contrary, it is intended to cover suchalternatives, modifications and equivalents as may be included withinthe spirit and scope of the invention as defined by the followingclaims.

1-20. (canceled)
 21. A method of treating a patient suffering from orsusceptible to at least one symptom of abuse of, dependence on, orwithdrawal from at least one substance, the method comprisingadministering to the patient a therapeutically effective amount ofnepicastat or a pharmaceutically acceptable salt thereof.
 22. The methodof claim 21, wherein the at least one substance is selected from a drugof abuse and a medication.
 23. The method of claim 22, wherein the drugof abuse is selected from a psychostimulant agent, an opioid, ahallucinogen, an inhalant, a sedative, a tranquilizer, a hypnotic, ananxiolytic, and an illicit substance.
 24. The method of claim 22,wherein the drug of abuse is selected from the group consisting ofcocaine, alcohol, caffeine, opium, cannabinoid, cannabis, benzodiazapinecarisprodol, tobacco, nicotine, Vicodin, Lorcet, Percocet, Percodan,Tylox, amphetamine, dextroamphetamine, methamphetamine, ecstasy,phenmetrazine, methylphenidate, diethylpropion, pemoline, mazindol, (−)cathione, fenfluramine, Lortab, Tramadol, heroin, methadone,hydrocodone, oxycodone, psilocybin, a hallucinogenic mushroom, lysergicacid diethylamide (LSD), phencyclidine (PCP), ketamine, benzene,toluene, o-xylene, m-xylene, p-xylene, ethylbenzene, fluorobenzene,o-difluorobenzene, 1,3,5-triflurobenzene, 1,2,4-trifluorobenzene,pentafluorotoluene, pentafluorobenzene, and perfluorobenzene.
 25. Themethod of claim 22, wherein the medication is selected from ananesthetic, an analgesic, an anticholinergic agent, an antihistamine, amuscle relaxant, a nonsteroidal antiinflammatory medication, an over thecounter medication, and an antidepressant medication.
 26. The method ofclaim 22, wherein the drug of abuse is cocaine and the nepicastat or thepharmaceutically acceptable salt thereof reduces at least one symptom ofcocaine abuse and dependence in the patient selected from attentiondeficit hyperactivity disorder; euphoria; increased energy, excitementand sociability; less hunger and fatigue; a marked feeling of physicaland mental strength; decreased sensation of pain; bronchitis; shortnessof breath; chest pain; heart palpitations; arrhythmia; cardiomyopathy;heart attack; dilated pupils; nausea; vomiting; headache; vertigo;dizziness; anxiety; pychosis; confusion; nasal irritation; nasalcrusting; recurrent nosebleeds; nasal stuffiness; facial pain;dysphoria; and craving for cocaine.
 27. The method of claim 21, whereinthe method further comprises co-administering a therapeuticallyeffective amount of least one other agent selected from a selectiveserotonin reuptake inhibitor (SSRI), a serotonin-norepinephrine reuptakeinhibitor (SNRI), a norepinephrine reuptake inhibitor (NRI), anorepinephrine-dopamine reuptake inhibitor (NDRI), a serotonin5-hydroxytryptaminelA (5HT1A) antagonist, a dopamine β-hydroxylaseinhibitor, an adenosine receptor antagonist, an adenosine A2A receptorantagonist, a monoamine oxidase inhibitor (MAOI), a monoamine oxidase Binhibitor, a sodium channel blocker, a calcium channel blocker, acentral and peripheral alpha adrenergic receptor antagonist, a centralalpha adrenergic agonist, a central or peripheral beta adrenergicreceptor antagonist, a NK-I receptor antagonist, a corticotropinreleasing factor (CRF) antagonist, an atypicalantidepressant/antipsychotic, a tricyclic, an anticonvulsant, aglutamate antagonist, a gamma-aminobutyric acid (GABA) agonist, a GABAmetabolism enzyme inhibitor, a GABA synthesis activator, a partialdopamine D2 agonist, a dopamine metabolism enzyme inhibitor, acatechol-O-methyl-transferase inhibitor, an opioid receptor antagonist,a mood stabilizer, a direct or indirect dopamine agonist, a partial 5HT1agonist, a serotonin 5HT2 antagonist, an opioid, a carboxylaseinhibitor, a partial opioid agonist, a partial nicotinic agonist, and aninhalant.
 28. The method of claim 21, wherein the method furthercomprises co-administering a therapeutically effective amount of leastone other agent selected from benzodiazepine, levodopa, carisprodol,modafenil, acamprosate, gamma-butyrolactone, gamma-hydroxybutyrate,opium, psilopcybin, hallucinogenic mushroom, tobacco, and nicotine. 29.The method of claim 21, wherein the nepicastat or the pharmaceuticallyacceptable salt thereof is administered to the patient after a period ofabstinence by the subject.
 30. A method of treating at least one phaseof cocaine dependence in a patient, wherein the at least one phase isselected from acquisition, maintenance, extinction, and relapse,comprising administering to the patient a therapeutically effectiveamount of nepicastat or a pharmaceutically acceptable salt thereof. 31.The method of claim 30, wherein the nepicastat or the pharmaceuticallyacceptable salt thereof inhibits the development of the acquisitionphase in the patient.
 32. The method of claim 30, wherein the nepicastator the pharmaceutically acceptable salt thereof promotes development ofthe extinction phase in the patient.
 33. The method of claim 30, whereinthe nepicastat or the pharmaceutically acceptable salt thereof reducesthe frequency of relapse in the patient.
 34. The method of claim 30,wherein the nepicastat or the pharmaceutically acceptable salt thereofreduces in the patient at least one symptom of abuse of, dependence on,or withdrawal from cocaine.
 35. The method of claim 34, wherein thenepicastat or the pharmaceutically acceptable salt thereof reduces atleast one symptom of cocaine abuse and dependence selected fromattention deficit hyperactivity disorder; euphoria; increased energy,excitement and sociability; less hunger and fatigue; a marked feeling ofphysical and mental strength; decreased sensation of pain; bronchitis;shortness of breath; chest pain; heart palpitations; arrhythmia;cardiomyopathy; heart attack; dilated pupils; nausea; vomiting;headache; vertigo; dizziness; anxiety; pychosis; confusion; nasalirritation; nasal crusting; recurrent nosebleeds; nasal stuffiness;facial pain; dysphoria; and craving for cocaine.
 36. The method of claim34, wherein the nepicastat or the pharmaceutically acceptable saltthereof reduces at least one symptom of cocaine withdrawal selected fromfatigue, lack of pleasure, depression, irritability, sleep disorders,increased appetite, pyschomotor retardation, agitation, extremesuspicion, and craving for cocaine.
 37. The method of claim 30, whereinthe method further comprises co-administering a therapeuticallyeffective amount of least one other agent selected from a selectiveserotonin reuptake inhibitor (SSRI), a serotonin-norepinephrine reuptakeinhibitor (SNRI), a norepinephrine reuptake inhibitor (NRI), anorepinephrine-dopamine reuptake inhibitor (NDRI), a serotonin5-hydroxytryptaminelA (5HT1A) antagonist, a dopamine β-hydroxylaseinhibitor, an adenosine receptor antagonist, an adenosine A2A receptorantagonist, a monoamine oxidase inhibitor (MAOI), a monoamine oxidase Binhibitor, a sodium channel blocker, a calcium channel blocker, acentral and peripheral alpha adrenergic receptor antagonist, a centralalpha adrenergic agonist, a central or peripheral beta adrenergicreceptor antagonist, a NK-I receptor antagonist, a corticotropinreleasing factor (CRF) antagonist, an atypicalantidepressant/antipsychotic, a tricyclic, an anticonvulsant, aglutamate antagonist, a gamma-aminobutyric acid (GABA) agonist, a GABAmetabolism enzyme inhibitor, a GABA synthesis activator, a partialdopamine D2 agonist, a dopamine metabolism enzyme inhibitor, acatechol-O-methyl-transferase inhibitor, an opioid receptor antagonist,a mood stabilizer, a direct or indirect dopamine agonist, a partial 5HT1agonist, a serotonin 5HT2 antagonist, an opioid, a carboxylaseinhibitor, a partial opioid agonist, a partial nicotinic agonist, and aninhalant.
 38. A method of treating a patient suffering from orsusceptible to at least one symptom of abuse of, dependence on, orwithdrawal from alcohol, the method comprising administering to thepatient a therapeutically effective amount of nepicastat or apharmaceutically acceptable salt thereof, wherein the nepicastat or thepharmaceutically acceptable salt thereof is administered to the patientafter a period of abstinence by the subject.
 39. The method of claim 38,wherein the method further comprises co-administering a therapeuticallyeffective amount of least one other agent selected from a selectiveserotonin reuptake inhibitor (SSRI), a serotonin-norepinephrine reuptakeinhibitor (SNRI), a norepinephrine reuptake inhibitor (NRI), anorepinephrine-dopamine reuptake inhibitor (NDRI), a serotonin5-hydroxytryptaminelA (5HT1A) antagonist, a dopamine β-hydroxylaseinhibitor, an adenosine receptor antagonist, an adenosine A2A receptorantagonist, a monoamine oxidase inhibitor (MAOI), a monoamine oxidase Binhibitor, a sodium channel blocker, a calcium channel blocker, acentral and peripheral alpha adrenergic receptor antagonist, a centralalpha adrenergic agonist, a central or peripheral beta adrenergicreceptor antagonist, a NK-I receptor antagonist, a corticotropinreleasing factor (CRF) antagonist, an atypicalantidepressant/antipsychotic, a tricyclic, an anticonvulsant, aglutamate antagonist, a gamma-aminobutyric acid (GABA) agonist, a GABAmetabolism enzyme inhibitor, a GABA synthesis activator, a partialdopamine D2 agonist, a dopamine metabolism enzyme inhibitor, acatechol-O-methyl-transferase inhibitor, an opioid receptor antagonist,a mood stabilizer, a direct or indirect dopamine agonist, a partial 5HT1agonist, a serotonin 5HT2 antagonist, an opioid, a carboxylaseinhibitor, a partial opioid agonist, a partial nicotinic agonist, and aninhalant.
 40. The method of claim 38, wherein the method furthercomprises co-administering a therapeutically effective amount of leastone other agent selected from benzodiazepine, levodopa, carisprodol,modafenil, acamprosate, gamma-butyrolactone, gamma-hydroxybutyrate,opium, psilopcybin, hallucinogenic mushroom, tobacco, and nicotine.